Mae Dica

Volume 11 Supplement 2016
Editor-in-chief Deputy Editors

Mircea CINTEZA (Romania) Dragos VINEREANU (Romania)
Bogdan O. POPESCU (Romania)
Senior Editors
Ioanel SINESCU (Romania) Managing editors
Alan G. FRASER (UK) Eliza Elena CINTEZA (Romania)
Adriana ILIESIU (Romania)
International Editorial Board Scientific Publishing Committee

(University of Medicine and Pharmacy
1. Martin BURIAN (Austria)
Carol Davila)
2. Gianfranco BUTERA (Italy)
3. Gheorghe CERIN (Italy) 1. Petru ARMEAN
4. Adrian COVIC (Romania) 2. Mihaela BALGRADEAN
5. Maurizio CUTOLO (Italy) 3. Ovidiu BAJENARU
6. Marco DIENA (Italy) 4. Mircea BEURAN
7. Heiner FANGERAU (Germany) 5. Dana BODNAR
8. Antonio FEDERICO (Italy) 6. Miron BOGDAN
9. Nicholas GOURTSOYIANNIS (Greece) 7. Alexandru BUCUR
10. Christopher GRANGER (USA) 8. Emanoil CEAUSU
11. Nicolae HANCU (Romania) 9. Delia CINTEZA
12. Marc HUMBERT (France) 10. Catalin CIRSTOIU
13. Mircea IVAN (USA) 11. Ileana CONSTANTINESCU
14. Vecsei LASZLO (Hungary) 12. Mircea DICULESCU
15. Gerald MAURER (Austria) 13. Ion FULGA
16. Serban MIHAILEANU (France) 14. Daniela FILIPESCU
17. Radu MIHAI (UK) 15. Mihai HINESCU
18. Lucian MIRON (Romania) 16. Ecaterina IONESCU
19. Piero PORTINCASA (Italy) 17. Ruxandra IONESCU
20. Schmidt THORSTEN (Germany) 18. Anca LUPU
21. Emil TOESCU (UK) 19. Dumitru LUPULIASA
22. Selman URANUES (Austria) 20. Dana MINCA
23. Victor VOICU (Romania) 21. Cristina PARVU DINU
22. Doina PLESCA
23. Bogdan A POPESCU
24. Adrian STREINU-CERCEL
25. Radu VLADAREANU
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A valuable Journal of clinical medicine, MAEDICA, has as a main purpose to enrich the
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Organizing committee
Acad. Ioanel SINESCU Congress Chairman, Rector

Prof. Dragos VINEREANU Congress Chairman, Vice-Rector
Prof. Mircea BEURAN President of the Senate
Prof. Ecaterina IONESCU Vice-Rector
Prof. Catalina POIANA Vice-Rector
Prof. Viorel JINGA Vice-Rector
Prof. Bogdan O. POPESCU Vice-Rector
Prof. Dumitru LUPULIASA Director of the Committee for PhD University
Studies
Prof. Catalin CIRSTOIU Dean
Prof. Doina DRAGANESCU Dean
Prof. Dana BODNAR Dean
Prof. Ileana CONSTANTINESCU Director of Department for Grants and Scientific
Research
Prof. Simona RUTA Vice-Dean for Scientific Research
Prof. Cristina PARVU Vice-Dean for Scientific Research
Prof. Mircea Ioan POPA Chairman of the Research Ethics Committee
Prof. Victor STRAMBU Chairman of the Senates Scientific Research
Committee
Prof. Victor PURCAREA Director of Publishing House Carol Davila
Prof. Dana MINCA Chairman of the Committee for Quality Assurance
Prof. Cristian CURCA Chairman of the Academic Ethics and Deontology
Committee
Prof. Octavian BUDA History of Medicine
Prof. Ruxandra IONESCU Former Vice-Rector
Prof. Anca Doina PLESCA Former Dean
Dr. Aurora PRUNESCU General Secretary
Ec. Doina CRISAN Administrative Director
Mdica - a Journal of Clinical Medicine
Content
Abstracts of posters exposed

at the Congress of the University
of Medicine and Pharmacy
Carol Davila, Bucharest
(June 2nd-4th 2016)
Young Investigator Award 3

Preclinical Specialities 3
Dental Medicine 6
Medical Specialities 9
Pharmacy 13
Surgical Specialities 16
Preclinical Specialities 21
Dental Medicine 47
Pharmacy 52
Medical Specialities 59
Surgical Specialities 133
Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 1

Y OUNG I NVESTIGATOR A WARD
PRECLINICAL SPECIALITIES neurons that were deprived from oxygen and glu-
cose. 2h OGD cells treated with oxytocin and
(195) Oxytocin effects on atosiban displayed a viability of 74.89%5.14%
(n=15), p=0.002.
mature hippocampal Conclusions: Oxytocin may be detrimental to
cultures during oxygen- mature neurons under ischaemic conditions,
whereas atosiban may increase cellular viability
glucose deprivation and by competitively blocking oxytocin.
reoxygenation
Diana Maria Chitimus, Ioana Florentina (171) Reductive stress for
Grigoras, Mara Iesanu, Bogdan Ianosi, manipulating fibroblast
Leon Zagrean, Ana-Maria Zagrean proliferation
Discipline of Physiology and Fundamental Ioana Sonia Iordache1, Mihaela
Neuroscience, University of Medicine and
Pharmacy Carol Davila, Bucharest, Romania
Mocanu1, Elena Codrici2, Simona
Mihai1, Daniela Ionela Popescu2,
Objectives: Oxytocin was found to increase Ana-Maria Enciu1, Gina Manda2
resistance to anoxic episodes in immature neu- 1
University of Medicine and Pharmacy Carol
rons. We have previously shown that oxytocin Davila, Bucharest, Romania
exerts a neuroprotective effect on immature hip- 2
National Institute of Pathology Victor Babes,
pocampal cultures subjected to oxygen-glucose Bucharest, Romania
deprivation (OGD) and reoxygenation, effect
mimicked by the NKCC1 inhibitor, bumetanide. Background: The redox status is tightly con-
In the present study we explore the oxytocin and trolling cellular morphology and function, and its
atosiban effect on mature neuronal cultures ex- pharmacologic manipulation may prove to be a
posed to OGD. valuable therapeutic tool in redox-mediated dis-
Methods: Primary cultures of hippocampal eases.
neurons were obtained from postnatal day 0 Wi- Objective: to investigate the impact of reduc-
star rat pups. Mature neuronal cultures, aged to tive stress, experimentally induced by N-acetyl-
7-8 days, were subjected to OGD or control con- cysteine (NAC), on fibroblasts proliferation.
ditions, with or without oxytocin. To evaluate the Method: Cells: mouse L929 fibroblasts. Cel-
effect of oxytocin in metabolic deprivation of dif- lular proliferation: real-time impedance measure-
ferent level of severity, we exposed the mature ments using the xCELLigence system; flow cytom-
hippocampal cultures to 1 h, 1.5 h and 2 h con- etry with CFDA-SE; reactive oxygen species (ROS)
trol and OGD conditions. Assessment of cellular production: flow cytometry with CM-H2DCFDA;
metabolism and viability was performed using signal transduction: phosphoprotein multiplexing
resazurine during a 3-hour reoxygenation in a using the Luminex200 platform.
normoglycemic medium. We also tested the ef- Results: Preliminary investigations, performed
fect of a competitive oxytocin receptor antago- for establishing the experimental settings, indi-
nist, atosiban, on neuronal viability in both con- cated that cell culture plates dedicated to imped-
trol and OGD conditions. ance measurements should be coated with colla-
Results: Oxytocin was shown to decrease the gen for favoring L929 adhesion. Reproducible
cellular viability measured by resazurine, both in adhesion and proliferation of L929 cells was ob-
control and OGD conditions, this effect being tained for 10.000 to 20.000 cells / well (30.000
maximal in the 2-hour exposures. The cells ex- 60.000 cells / cm2).
posed to 2h OGD showed a 78.924.10 viability Treatment of L929 cells with NAC reduced
while those exposed to 2h OGD with oxytocin ROS production by L929 cells and consequently
showed a viability of 54.54%4.10% (n=21), the level of oxidated thiols, probably through the
p=0,0001. Atosiban seemed to significantly increase of glutathione level. Real-time imped-
counteract the effect of oxytocin receptors in the ance measurements indicated that NAC exerted

ABSTRACTS
an anti-proliferative effect on adhered L929 fi- units, using a desktop nephelometer. 500 L of
broblasts. The effect was dose-dependent in the bacterial suspension was co-incubated with dif-
concentration range (0.25 10)mM NAC. The ferent concentrations of Cefoxitin (FOX) suspend-
inhibitory action was obvious 12 h after addition ed in 100 L of fresh MH. Standard dilution anti-
of 5-10 mMNAC to adhered L929 fibroblasts. Im- biogram was done to confirm FOX susceptibility.
pedance data were confirmed by flow cytometry Results: S. aureus ATCC29213 had a FOX
using CFDA-SE, showing the arrest of cells in ear- MIC of 4 g, while ATCC43300 FOX MIC was 32
lier daughter generations as compared to the un- g. Staphylococcus aureus ATCC29213 showed
treated control. Moreover, the study evidenced rapid growth (within 2 hours) when co-incubated
that L929 cells repeatedly treated with 10 mM within the 0-4 g of FOX, showing a methicillin-
NAC maintained a lower proliferation capacity susceptibility profile (MSSA). This was not true for
even after NAC removal. The signal transduction higher concentrations of FOX. Staphylococcus
assay indicated that the anti-proliferative effect of aureus ATCC43300 showed rapid growth within
NAC on L929 fibroblasts was mediated by inhibi- a higher concentration range, showing rapid
tion of the MAP kinases ERK and p38. growth even in the 8-16 g range and delayed
Conclusion: Proliferation of fibroblasts could growth (6-8 hours) in 32-64 g range.
be inhibited by repeated treatment with NAC. Conclusions: Microcalorimetry allows for the
This therapeutic approach may show relevance rapid differentiation of MSSA and MRSA. Clinical
for controlling the wound healing process or tu- and Laboratory Standards Institute (CLSI) adapted
mour progression. antibiotic susceptibility testing was shown to diag-
Acknowledgment: This work was partially fi- nose a MRSA profile within 4-6 hours, but re-
nanced by the CERN-RO Programme through the quires the use of multi-channel microcalorimetry.
project E05/2014 RADIOMED. The investigational protocol uses a higher inocu-
lum of bacteria and a direct FOX challenge taking
advantage of the real-time nature of microcalori-
(331) Direct Cefoxitin metric monitoring. To this end, it can detect the
challenge of Staphylococcus rapid growth associated with bacterial resistance
in less than 2 hours.
aureus ATCC 29213 and
43300 strains leads to rapid (153) Salivary biomarkers
differentiation of antibiotic of inflammation: clinical
susceptibility pattern significance in systemic
Andrei-Alexandru Muntean, Dragos lupus erythematosus
Cosmin Zaharia, Madalina Maria Florea,
Iulia-Ioana Stanescu, Bogdan Calenic,
Adrian Poenaru, Octavian Costin
Alexandra Totan, Daniela Miricescu,
Ioghen, Mihaela Roxana Huhu, Andrei
Radu Radulescu, Roxana-Maria-Justina
Neagu, Ioana Andreea Ghita, Mihnea
Varlan, Maria Greabu
Ioan Gabriel Popa, Miron Alexandru
Bogdan, Vlad Tudor Popa, Mircea Ioan Department of Biochemistry, University of
Medicine and Pharmacy Carol Davila, Bucharest,
Popa Romania
Davila, Bucharest, Romania Objectives: Saliva is a remarkable diagnostic
fluid being used for monitoring a wide range of
Objectives: To evaluate a microcalorimetric local and systemic diseases. However, the link be-
protocol for rapid differential diagnosis between tween salivary diagnosis and the inflammatory
methicillin susceptible and methicillin resistant process in autoimmune diseases has not yet been
Staphylococcus aureus (MSSA and MRSA). explored. In this context, the main aim of our
Methods: Two reference strains of Staphylo- study is to quantify salivary biomarkers specific
coccus aureus were used (ATCC29213 and for the inflammatory process in systemic lupus
ATCC43300). Overnight cultures of S. aureus in erythematosus (SLE) patients and to correlate
Mueller Hinton (MH) were pelleted by centrifu- these levels with their serum concentrations.
gation (2x 3000rpm) and washed 3 times with Method: The study included 9 patients fulfill-
fresh MH medium. The bacteria were then sus- ing the Systemic Lupus International Collaborat-
pended to a concentration of 0.5 McFarland ing Clinics (SLICC) diagnosis criteria and 5 healthy
4 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

ABSTRACTS
subjects as control group. Salivary and serum lev- 1 staining), reactive oxygen species (carboxy-
els of interleukin-6 (IL-6), leptin, monocyte che- H2DCFDA staining) and intracellular proteins af-
moattractant protein-1 (MCP-1) and plasminogen ter fluorescent staining (ERK/pERK, c-Fos). The
activator inhibitor-1 (PAI-1) were determined us- ability of curcumin to inhibit colony formation
ing stochastic sensors. was investigated by clonogenic assay. The con-
Results: IL-6, leptin and MCP-1 (but not PAI- centrations of curcumin during treatments varied
1) salivary and serum levels were higher in all SLE from 0.1-100 M and time incubation was opti-
cases when compared to their respective con- mized for each assay.
trols. At the same time statistically significant cor- Results: Administration of curcumin in cul-
relations between serum and saliva were found ture for 72 h blocked the cancer cells in G2/M,
only for IL-6 [med (inf; sup) 2.6(0.2 4.7) vs. more efficiently in MCF-7 cells compared to SK-
0.8(0.4 1.2) pg/mL; p=0.029, 2.7(1.7 5.3) vs. BR-3 cells. The expression level of c-Fos, ERK and
1.2(0.5 1.7) pg/mL; p<0.001, respectively in a lower extent pERK was reduced after cur-
cumin treatment, MCF-7 cells being more sensi-
118.9(53.5 182.2) vs. 51.4(32.4 137.2) ng/
tive than SK-BR-3 cells. Curcumin reduced clono-
mL; p=0.029]. Positive correlations were also
genic survival for both MCF-7 and SK-BR-3, with
found for serum concentrations of leptin and
greater potency in case of ErbB2+ cell line. A
MCP-1.
significant increase in ROS was noticed in both
Conclusions: The positive correlation be- cell lines in correlation with mitochondrial mem-
tween salivary and serum IL-6 levels promotes brane potential collapse after administration of
salivary IL-6 levels as a useful marker to evaluate curcumin.
the inflammatory process in SLE. The present Conclusions: Curcumin displayed anti-can-
study supports the hypothesis that saliva is a mir- cer properties in both breast cancer cell lines ER+
ror of the body, acting as a diagnostic fluid that and ErbB2+, demonstrating that might be a use-
can be used to detect and monitor both oral and ful therapeutic agent against such malignancies.
systemic diseases.
(117) Creating cheap
(221) Anti-proliferative
affordable insulin pumps
effect of curcumin in ER+
with innovative electronics
and ErbB2+ mammary
and 3D printing
cancer cell lines
Roxana Monica Ionita1, T. Milian1,
Alexandru Filippi, Constanta Ganea, S. Ioacara1, M. Purcaru2, I. Herescu1,
Maria-Magdalena Mocanu Simona Fica1
University of Medicine and Pharmacy Carol 1
Davila, Bucharest, Romania Davila, Bucharest, Romania
2
X-projects Association
Objectives: Breast cancer is the most fre-
quent malignancy in women world-wide and is Objectives: Technology comes with a price,
also responsible for the most deaths. A polyphe- and is this precise cost that limits its widespread
nolic compound derived from Curcuma longa use. The aim of our study was to obtain a proof of
roots, curcumin, displayed several anti-cancer concept that an accurate, precise and cheap (un-
activities. Our main objectives of the study were: der 300) insulin pump can be created.
to evaluate the effect of curcumin on cell cycle Methods: A small and compact insulin pump
progression, to investigate the ability of curcumin was created using innovative electronics and 3D
to reduce the phosphorylation of intracellular printing technology. All communications are
proteins, to examine the effect of curcumin on made through a Bluetooth LE connection with a
cell clonogenicity, mitochondrial membrane de- mobile device running a dedicated App. Cyberse-
polarization and on production of the reactive curity measures ensures safety against common
oxygen species (ROS) in two breast cancer cell threats. Accuracy and precision was tested against
lines (MCF-7 and SK-BR-3). a 0.5U step insulin pen by air delivering of 15U of
Methods: MCF-7 (ER+) and SK-BR-3 regular insulin for 15 times with both devices and
(ErbB2+) cell lines were grown according to their counting the number of insulin drops obtained.
specifications. Flow cytometry technique was The experiment was then repeated with new car-
used to analyze cell cycle progression (PI/RNase tridges, finally obtaining 30 measurements for
staining), mitochondrial membrane potential (JC- each device. Pump bolus programing was avail-

ABSTRACTS
able in 0.15U incremental steps. The experiment have been characterized by an overexpression of
was video recorded. the receptor protein CD44 +. Nanoparticles
Results: There was no significant difference in (NPs) are capable of carrying substances to differ-
number of insulin drops obtained for 15U insulin ent body regions. Polymeric NPs are studied in
delivery with both the pen (44.81.3 drops) and various fields of dentistry, from periodontics to
the pump (45.51.7 drops, p=0.075). Similar endodontics. Due to their controlled delivery
results were obtained comparing mean number proprieties, polymeric NPs might be used to spe-
of drops obtained with first cartridge (45.31.1 cifically transport anticancer drugs to the oral
drops pen vs. 46.11.5 drops pump, p=0.129) CSC.
or the second one (44.31.4 drops pen vs. Objectives: The aim of this study was to verify
451.7 drops pump, p=0.249). Within cartridge the selective binding of the chitosan NPs to the
variation for 15U pump insulin delivery was not oral CSC. CSC were isolated from the CA1 cell
significant: 46.11.5 drops for first 7 commands line (derived from a biopsy of OSCC of the floor
(14 tests for 2 cartridges), and 451.6 drops for of the mouth) using flow cytometry techniques.
next 8 commands (16 tests for 2 cartridges, CSC were exposed for 24h to different concen-
p=0.058). Similar results were obtained for pen trations of polymeric NPs: 5 g/mL, 20 g/mL and
delivery. 200 g/mL. Two types of polymeric NPs were
Conclusions: Investigational pump delivered used in this study: PLGA NPs and PLGAChi (chi-
similar number of insulin drops for a standard bo- tosan covered PLGA NPs). Poly-lactic-co-glycolic
lus (15U) as compared with a standard pen (pre- acid is a synthetic biodegradable polymer, while
cision). Similar amount of insulin was delivered at chitosan is obtained from chitin, a polysaccharide
the beginning of the insulin cartridge compared found in crustaceans.
with middle to advanced position of pump piston Methods: CA1 cells were seeded in 6 well
(accuracy). Precision and accuracy were stable culture plates for 24 h. Afterwards, cells were ex-
when testing was repeated with new insulin car- posed for 24h at PLGA NPs and PLGAChi NPs.
tridges. Building a precise, accurate and cheap Fluorescence-activated cell sorting was used to
insulin pump is possible, and might have remark- measure the uptake of NPs by the cells. CSC were
able consequences on those in need. recognized using the antibody staining with
CD44-PE (clone G44-26, BD Bioscience). The
DENTAL MEDICINE DAPI nuclear dye was used to exclude dead cells.
Results: There is supporting evidence of the
selective binding and uptake of chitosan labelled-
(318) Selective binding of nanoparticles by cells expressing high levels of
Chitosan nanoparticles to CD44+. This was observed mainly at the concen-
trations 20 g/mL and 200 g/mL. Interestingly,
cancer stem cells PLGA didnt seem to enter CSC, even at the high-
Maria Justina Roxana Virlan2, Daniela est concentration 200 g/mL.
Conclusions: The specific incorporation of
Elena Costea1, Bogdan Calenic2, Adrian
PLGAChi by CSC could be very efficient in oral
Biddle2, Ian Mackenzie3, Cristina M. cancer treatment. In the future, NPs loaded with
Sabliov2, Alexandra Totan4, Maria anticancer drugs might be used to selectively kill
Greabu2 only the tumor initiating CSC.
1
Faculty of Dental Medicine, University of
Medicine and Pharmacy Carol Davila, Bucharest, (263) Craniofacial skeletal
Romania
2
development of obese
Davila, Bucharest, Romania children and adolescents
3
The Gade Laboratory of Pathology, Bergen, Dan Stefan Simota, Viorica Milicescu
Norway
4
University of Bergen, Norway University of Medicine and Pharmacy Carol
Davila, Bucharest, Romania
Objectives: Oral cancer is the sixth most
common cancer worldwide. Recent publications Objectives: The prevalence of overweight
speak about the existence of cancer stem cells and obesity in most developed and developing
(CSC), a subpopulation of cells having tumor-ini- countries has been markedly increasing in recent
tiating ability and heightened resistance to thera- years. This is seen among all genders, ages, racial,
py. In oral squamous carcinoma (OSCC), CSC ethnic groups, and educational levels.

ABSTRACTS
The purpose of this study was to investigate (238) Gingival involvement

craniofacial skeletal morphology in overweight
and obese adolescents and to compare morpho- in autoimmune dermatoses
logical data with the normal development of the with oral manifestations
corresponding age. In the same time the study
was designed to establishing correlations between Elena Ioana Tofan, Ioanina Parlatescu,
obesity ethiological factors (genetic, endocrine, Carmen Gheorghe, Lelia Mihai, Serban
hormones and nutrients) and the consequences Tovaru
on scheletal variations.
Methods: The study was based on 24 over- University of Medicine and Pharmacy Carol
weight and obese patients of Orthodontic Center Davila, Bucharest, Romania
Carol Davila Bucharest with a BMI from 25 to 34,
aged between 7 and 16 years old, of which 13 Objectives: The gingival manifestations are
are girls and 11 boys. BMI is calculated by divid- frequently encountered in autoimmune skin dis-
ing weight by squared height (BMI=kg/m2). BMI eases with oral involvement. They are usually
calculation is different for individuals that are un- named descuamative gingivitis. The oral signsvary
der twenty years old. It is calculated the same as from asymptomatic white lesions, mucosal atro-
adults, but is is compared with typical values for phy, erosions and bullae to wide, painful ulcers.
other children of the same gender and age (BMI The aim of this study was to detect the frequency
percentile), allowing comparison with children of of gingival involvement in patients with autoim-
the same age and gender. Craniofacial values mune dermatoses.
were obtained from lateral cephalometric trac- Methods: We reviewed a number of 1440
ings with linear and angular measurements and medical charts of patients with autoimmune skin
compared with normal standards of develop- diseases examined and diagnosed in the clinical
ment. department of Oral Pathology Discipline (1999 -
Results: On the basis of the measurements of May 2015). In this study we included the patients
skeletal parameters obtained in correlation with diagnosed with oral lichen planus (OLP) or auto-
normal standards of development for each age immune blistering diseases. The inclusion criteria
and gender, shows a hyper divergence profile were the presence of gingival lesions and the con-
types for 21 of 24 overweight and obese subjects firmation of the diagnosis by clinical means and/
with an increased sphenoid angle for 19 of them. or histology for OLP and clinical signs associated
Furthermore an oversized sphenoid angle corre- with histology and direct immunofluorescence
sponds with a deep palace (V-Nsp decreased). for oral blistering diseases.
Posterior maxillary rotation presents 20 of 24 Results: From the total of 1440 patients with
obese patients in association with dysfunctional OLP 325 (23%) cases presented gingival involve-
etiology (56%), genetic (29%), endocrine factors ment. From a total of 50 patients with confirmed
(15%). oral blistering autoimmune diseases, 24 cases
Conclusions: Both male and females over- (48%) presented descuamative gingivitis. In OLP
weight and obese exhibited significantly larger group the most of the patients were women 259
skeletal development of the cranium and face. out of 302, the average age was 59,2 years and
Vertical jaw is wider and has an anteroposterior the mean age 58. In the autoimmune blistering
orientation. Based jaws, mandibular body and diseases group 75% were women, the average
paranasal sinuses are characterized by massive- age was 62.41 years and the mean age was 66.
ness with relatively greater measurements. Etio- The presence of skin lesions was mentioned in 39
logical factors of obesity can shape craniofacial cases of OLP but in no case of autoimmune blis-
skeletal morphology. tering diseases. The oral lesions are present at the
onset of the blistering diseases and are followed
by cutaneous lesions in a periodvariable from 3-6
months. An interesting fact is that in 27 cases the
gingival lesions were the only oral clinical sign -
23 cases in OLP and 5 cases of blistering autoim-
mune diseases (3 pemphigus vulgar and 2 mu-
cous pemphigoid). The remaining 302 OLP
patients associated other lesions such as keratosis,
atrophy, erosions located on other sites of the oral
mucosa.
Conclusion: The descuamative gingivitis no-
ticed in autoimmune dermatosis with oral mani-

ABSTRACTS
festations is a frequently encountered entity ders; the most common complication that we
which can raise a great challenge for the diagnosis found is represented by displacements (50%), fol-
mainly if it is an unique clinical sign. lowed by impactations of the adjacent teeth
(33.3%). 22.2% of the supernumerary teeth de-
(184) Clinical problems termined overcrowding. One supernumerary
tooth (5.5%) resulted in a cystic degeneration - a
associated with the residual follicular cyst.
supernumerary teeth Conclusions: Supernumerary teeth may in-
duce many complications in the dental arches, of
Florina-Maria Mandoiu1, Anca-Oana which the most common are: displacements, im-
Dragomirescu2, Ronen Boiangiu3, Raluca pactations, crowding of the adjacent teeth or cys-
Grigore3, Elina Teodorescu3, Ecaterina tic degenerations. Early detection of the disorders
caused by supernumerary teeth is important in
Ionescu1
terms of drawing up a treatment plan, influenced
1
Department of Orthodontics and Dentofacial mainly by the type, position, relationship and ef-
Orthopedics, Faculty of Dentistry, University of fects they have upon the adjacent structures.
Romania
2
Faculty of Dentistry, University of Medicine and
(65) Association between
Pharmacy Carol Davila, Bucharest, Romania oral health literacy for
3
University of Medicine and Pharmacy Carol teenage students and self-
reported health status and
Objectives: Supernumerary teeth define the dental attendance
existence of one or more teeth (erupted or in-
traosseous), in addition to the current dental for- Mariana Caramida, Adina Dumitrache,
mula. Due to their high degree of morphological Roxana Ilici, Ruxandra Sfeatcu, Ecaterina
and topographical variability many complications Ionescu
may arise, with a great impact upon the adjacent
teeth, guiding therefore the practician towards a University of Medicine and Pharmacy Carol
radical treatment planning (consisting in dental Davila, Bucharest, Romania
extractions) or a conservative one (non-extrac-
tional). This study was designed to evaluate the Objectives: This cross-sectional study in Bu-
prevalence of the complications induced by the charest aims to evaluate the relationship between
supernumeraries. the level of oral health literacy, reasons for dental
Methods: We studied a group of 15 patients visits and self-assessment health status in a group
with supernumerary teeth, aged between 6 and of 185 teenage schoolchildren with mean age
24 years, who applied for specialized check-ups 13.98 years (SD1.64).
at the Department of Orthodontics and Dentofa- Methods: Were collected data on oral health
cial Orthopedics at the Faculty of Dentistry of the literacy level with REALD-30, a word recognition
Carol Davila University of Bucharest. The radio- tests, with score ranges from 0 to 30. Oral health
logical investigations and medical records of each literacy level was correlated with self-reported
patient were analyzed in order to determine the oral health status and problem-based dental at-
clinical problems determined by the supernumer- tendance. The ethics committee of the UMP
ary teeth. Observations were also made on the Carol Davila approved this study.
number of supernumerary units that each patient Results: Mean score for REALD-30 is 23.70
presented, their distribution on the two maxillar- (SD3.71). Only 27.6% of adolescents have an
ies and presence on the dental arch or state of increased level of oral health literacy (scores be-
impactation. tween 26 and 30 points). For 43.2% self-reported
Results: A total of 18 supernumerary teeth oral health is good/very good. There is a statisti-
were found for the 15 patients included in the cally insignificant correlation between literacy
study: 13 of them had one supernumerary unit level and self-reported health, students with low
(86.6%), one (6.6%) - two supernumerary teeth literacy level reported fair/poor oral health status
and another one (6.6%) - three supernumeraries. (p=0.45). There is a statistically significant corre-
Most supernumerary teeth were located in the lation between oral health literacy level and den-
maxilla (n = 13, 72.2%). A percentage of 94,4% tal visits (p=0.04), those with high oral health
of the evaluated supernumeraries caused disor- level have regular dental check-ups. Conclu-

ABSTRACTS
sions: Oral health literacy level was a risk indica- asymmetry appears as a compensatory fact of pri-
tor for fair/poor self-reported oral health domains mary asymmetry.
and for dental visits in emergency or because of a
problem. Oral health education in schools must MEDICAL SPECIALITIES
be a component of the strategy to increase health
literacy level among teenagers in order to im- (62) 4D echocardiographic
prove dental knowledge and oral self-care behav-
ior. This work was supported by Carol Davila and arterial stiffness
University of Medicine and Pharmacy from re- parameters and cardiac
search project number 33898/11.11.2014.
biomarkers in early
(148) Statistical diagnosis and prediction of
considerations on facial chemotherapy-induced
asymmetry cardiotoxicity in
nonHodgkin lymphoma
Andreea Raluca Hlatcu1, Elina
Teodorescu2, Elena Galan1, Cristina patients
Pomana1, Ecaterina Ionescu2 Diana Mihalcea1, Maria Florescu1,
1
University of Medicine and Pharmacy Carol Dragos Vinereanu1,2
Davila, Bucharest, Romania 1
2
Department of Orthodontics and Dentofacial Davila, Bucharest, Romania
Orthopedics, Faculty of Dentistry, University of 2
Emergency University Hospital, Bucharest,
Medicine and Pharmacy Carol Davila, Bucharest, Romania
Romania
Objectives: CHOP (cyclophosphamide, hy-
Objectives: facial asymmetry is associated droxydaunorubicin (doxorubicin), oncovin, pred-
with maxillary alveolar dental disharmonies nisone) use in non-Hodgkins lymphoma (NHL) is
which may belong to both transversal and vertical limited by the risk of cardiotoxicity, favoring in-
plans. creased morbidity and mortality. To define new
The research aimed to determine the primary parameters of 4D LV deformation, arterial stiff-
installation plan of skeletal facial asymmetry and ness and biomarkers, for early diagnose and pre-
compensatory three-dimensional changes, gener- diction of cardiotoxicity.
ated by it in the maxillary dental anomalies. Methods: 48 patients (18 men, 6013years),
Methods: the study was realized on a sample with NHL, with LVEF greater than 53%, sched-
consisting of 41 patients aged between 7 and 37 uled to receive CHOP, were assessed at baseline,
years old, of which 22 are male and 19 female. after 3rd and 6th cycle of CHOP (doxorubicin
Cephalometric analysis were performed, calculat- cumulative dose 34449mg). 4D echocardiogra-
ing defining parameters for development in the phy (4DE) was used to assess LVEF and LV systolic
transverse and vertical plans on the frontal cepha- deformation: longitudinal, radial, circumferential
lograms using combined analysis Ricketts, Lan- and area strain (LS, RS, CS, AS), Arteriograph to
glade. measure pulse wave velocity (PWV) and augmen-
Results: processing of the obtained data indi- tation index (AIX) and troponin I and NTproBNP
cates a balanced and homogenous composition were measured as markers of cardiac injury and
of the subjects selected. Permanent anatomic high overload. Cardiotoxicity was defined as a
forms of the asymmetry occurring during growth, decrease of LVEF below 53%, with more than
including those with dysfunctional etiology cor- 10% from the baseline value. Results: After the
responds to 58.7% of patients in the group aged 6th cycle, 12 patients (25%) (Group I) developed
over 20 years. cardiotoxicity (LVEF=623 vs 501, p<0.0001),
Conclusions: development asymmetry never while 36 patients (group II) did not (LVEF=633
appeared primary in vertical plan. One third of vs 552, p<0.0001). There was a significant re-
investigated subjects developed asymmetry in duction of all LV deformation parameters starting
vertical plan, second to a primary asymmetry in with the 3rd cycle and an increase of arterial stiff-
transverse plan. Development of asymmetry in ness, but group I had greater changes than group
vertical plan, in terms of the installation moment II (p<0.001). Univariate analysis showed a sig-
and coexistence with transverse development nificant correlation between the LVEF reduction

ABSTRACTS
and the decrease of LS, CS, RS, AS and increased bone metabolism and dual X-ray absorptiometry
PWV and troponin level after the 3rd cycle (r was used to determine the BMD at lumbar and
=0.490; r =0.335, r =0.422, r =0.418, r= femoral neck level. Other analyzed variables
-0.594, r =-0.314 respectively, all p<0.05). The were body mass index, fasting plasma glucose
reduction of the LS after the 3rd cycle was the and HbA1c.
best independent predictor for the decrease of Results: BMD at the lumbar spine (-3.370.75
LVEF after the 6th cycle (R2=0.241, p=0.0001). vs. -3.170.67) and femoral neck level
ROC analysis showed that a decrease of LS with (-2.360.65 vs. -2.300.82) was higher in dia-
more than 18% after the 3rd cycle predicted with betic group than control group at baseline. After
a Sb of 100% and Sp of 71% the development of one year of BT significant increases in BMD, es-
cardiotoxicity after the 6th cycle. pecially at the lumbar spine (-2.960.80 vs.
Conclusions: Assessment of cardiac biomark- -2.750.74), were noted in both groups. There
ers, arterial stiffness and 4DE myocardial defor- was no statistically significant difference between
mation parameters are able to detect early che- two groups at baseline and one year later. Serum
motherapy-induced cardiotoxicity and to predict osteocalcin (22.2614.49 vs 28.3410.67 ng/
further decline of LVEF in patients with NHL. Fur- ml) and serum cross laps (0.340.19 vs.
ther studies are needed in order to assess if these 0.490.22 ng/ml) have been significantly lower
parameters can be used into routine clinical prac- compared to the control group at the start of the
tice. study. After a year of BT, serum osteocalcin and
cross laps decreased in both studied groups, but
(333) Evaluation of bone with no statistical significance. Serum AP was
lower in diabetic group than control group at
mineral density and bone baseline and decreased in both groups one year
turnover in women with later. There was no statistically significant differ-
ence between studied groups at baseline and af-
type 2 diabetes and ter one year.
postmenopausal Conclusions: In the diabetic women bone
osteoporosis turnover is low. After one year of BT there was a
significant benefit at lumbar spine BMD. The us-
Raluca Cursaru1, Adrian Cursaru1, age of the bone turnover markers in patients with
Ramona Maria Dragut1, Emilia Rusu1, T2D could represent a screening method of bone
damage.
Florentina Radu1, Daniel Grigorie1,
Madalina Musat2, Gabriela Radulian1
1
(201) Immunologic markers
Davila, Bucharest, Romania for coeliac disease
2
National Institute of Endocrinology C.I. Parhon, monitoring
Bucharest, Romania
Iulia Enache1, Catalina Bardas2, Vasile
Objectives: Type 2 diabetes (T2D) is associ- Daniel Balaban1, Nicoleta Lacatus3,
ated with an increased risk of fractures although Mariana Jinga2, Alina Popp1
bone mineral density (BMD) seems to be normal 1
or higher. The aim of this study was to evaluate Central University Emergency Military Hospital,
markers of bone turnover and BMD in women Bucharest, Romania
2
with T2D and recently diagnosed postmenopaus- National Institute for Mother and Child Health,
al osteoporosis. Bucharest, Romania
3
Methods: Two groups of women have been University of Medicine and Pharmacy Carol
evaluated at baseline and one year later, after Davila, Bucharest, Romania
bisphosphonate treatment (BT): a group of 60
women diagnosed with T2D and newly post- Objectives: Our aim was to evaluate the util-
menopausal osteoporosis (diabetic group) and a ity of different serological tests in coeliac disease
group of 60 women only with postmenopausal (CD) monitoring. At present, these tests are most-
osteoporosis (control group). The bone turnover ly used for diagnosing CD.
markers such osteocalcin and alkaline phospha- Methods: Altogether 63 newly CD diagnosed
tase (AP) (bone formation markers) and cross laps children were included in the study. The children
(bone resorption marker) were used to evaluate were diagnosed at National Institute for Mother
and Child Health according with current ESP-

ABSTRACTS
GHAN CD diagnosis guidelines. Data regarding (205) Protective effects of in

gender, age, investigations at diagnosis, compli-
ance with a regular follow-up and adherence to vitro preconditioning with
gluten free diet (GFD) were collected for all. sevoflurane on human
Quantitative determination of serum celiac spe-
cific autoantibodies: IgA-antitransglutaminase2
endothelial progenitors
(tTG2-IgA, positive cut-off 20U) and antiendo- Marleen Sandmann1, Marilena Gilca1,
misium (EMA, positive cut-off at serum dilution of Laura Ceafalan1, Mihaela Surcel2,
1:5) were done with the ocasion of their regular
follow-up visits.
Gheorghita Isvoranu1, Gina Manda1,
Results: Median age at diagnosis was 5 years Adelina Vlad1
with a sex ratio girls:boys of 1.86. Nineteen chil- 1
dren did not require small-bowel biopsy for CD Davila, Bucharest, Romania
confirmation according with ESPGHAN criteria. 2
Departement of Development in the Pathology
Mean period of compliance for regular follow-up Domain and Biomedical Science, National
was 2 years. Transgressions from the GFD were Institute of Research Victor Babes, Bucharest,
declared by 8 children. Both tTG-IgA and EMA Romania
antibodies showed positivity 18 months after the
diagnosis in up to 29% children declaring strict Background: Endothelial progenitor cells
avoidance of gluten. The percentage of children (EPCs) have important roles in vessel and tissue
with negative seroconversion is significantly high- repair; however, their regenerative potential is
er in biopsy-proven than in serology based diag- impaired by the poor survival in the ischemic
nosed children. After two years of GFD, only 31 microenvironment. Recent data suggest a promis-
(49%) children showed negative seroconversion ing potential of volatile anesthetics for improving
of tTG2-IgA and 47 (74%) EMA. stem cells biology. Thus, we hypothesized that in
Conclusions: Children with only serology vitro exposure to sevoflurane could stimulate
based diagnosis seem to be less adherent to the EPCs growth and viability.
GFD and to the regular follow-up. EMA is the first Methods: Mononuclear cells isolated from
antibody to react to GFD, tTg-IgA being the last to human umbilical cord blood by gradient centrifu-
seroconvert. The high proportion of patients with gation were suspended in endothelial growth me-
still positive antibodies after 2 years on GFD sug- dium EGM2 and plated on fibronectin coated
gests the necessity of a frequent and regular fol- dishes. After five days in culture, the cells were
low-up. The discrepancy between the number of exposed for one or two hours to sevoflurane 2%
children that reported adherence to GFD and the or 4% in air/5% CO2, or only to air/5% CO2 (con-
number of children that became seronegative in- trol) in a modular chamber. 24 or 48 hours post-
dicate the utility of the serological tests in long exposure, viability, proliferation and apoptosis
term follow-up of CD. were assessed using lactate dehydrogenase (LDH)
leakage assay, methyl tetrazolium salt assay and
FITC-annexin V/ propidium iodide staining.
Results: LDH leakage was discretely lowered,
whereas the levels of formazan were increased (p
<0.05 for 1 h incubation with 4% sevo at 24 hrs,
and with 2% sevo at 48 h postexposure, n = 4) in
treated vs control samples. A 2 hrs precondition-
ing protocol indicated a prompter expansion of
cultures exposed to 2% than to 4% sevoflurane.
Early (p <0.05, n = 5) and late apoptosis (p
<0.05 only for 2% sevoflurane, n = 5) were di-
minished in preconditioned samples.
Conclusions: Sevoflurane has protective ef-
fects on viability and proliferation of human EPCs,
suggesting a promising potential of volatile anes-
thetics for improving the regenerative abilities of
endothelial progenitors. The in vitro exposure to
2% sevoflurane for two hours seems to be an ef-
ficient priming protocol.

ABSTRACTS
Financial support: Research grant PN-II-RU- that one hundred ninety-one (44.2%) of current
TE-2012-3-0463, UEFISCDI Romania, University smokers want to stop smoking and two hundred
of Medicine and Pharmacy Carol Davila, Bucha- forty (56%) have already tried it, but they failed.
rest, Romania. Eighty (18.5%) medical students quit smoking and
National Institute of Research Victor Babes the main reason was because smoking is harmful
Development in the Pathology Domain and Bio- to human health (62.7%). Two hundred twenty-
medical Sciences, Bucharest, Romania. six (52%) consider that they won`t quit and still
be smokers the next year.
According to the Fagerstrom test, 59% were
(90) The influence of evaluated to have low dependence, 33% moder-
tobacco use among medical ate dependence and 8% high dependence.
Conclusions: The results of current study in-
students from University of dicate a need to provide comprehensive tobacco
Medicine and Pharmacy control programs among medical students, and
smoking cessation programs. An unceasing effort
Carol Davila is needed by all concerned to reduce the number
Simona Costache1, Oana Deleanu1,2, of smokers between medical students.
Corina Oprea2, Ioana Munteanu2,
Florin Mihaltan1,2 (82) The reproducibility of
1
University of Medicine and Pharmacy Carol 3D versus 2D
Davila, Bucharest, Romania echocardiography in
2
Institute of Pneumoftiziology Marius Nasta,
Bucharest, Romania
measuring left ventricular
volumes and ejection
Objectives: This study aims to investigate cig- fraction according to the
arette smoking among a sample of medical stu-
dents and their attitudes towards smoking at the level in training in
University of Medicine and Pharmacy Carol Da- echocardiography
vila, Bucharest, Romania: what students know
about smoking, what is their level of addiction, Andreea Velcea1, Sorina Mihaila2,
and moreover, the reasons why they use ciga- Roxana Cristina Rimbas2, Lavinia Matei1,
rettes. Anca Andronic1, Simona Ionela Calin1,
Methods: A questionnaire was distributed to
the medical students of the University of Medi-
Denisa Muraru3, Luigi Paolo Badano3,
cine and Pharmacy Carol Davila, Bucharest, Ro- Dragos Vinereanu1
mania, from February 14 to March 18, 2016. This 1
study was addressed to first year, fourth year and Davila, Bucharest, Romania
sixth year medical students. 969 medical students 2
answered the questionnaire. The questionnaire Romania
was composed of 30 questions: 13 common 3
University of Padova, Italy
questions (smokers and non-smokers), 11 ques-
tions for smokers, and 6 questions were repre- Objectives: To establish if 3D echocardiogra-
sented by the Fagerstrom test for nicotine depen- phy (3DE) provides more reproducible results in
dence. Data analysis was performed using the evaluation of left ventricular (LV) volumes and
descriptive statistics. ejection fraction (EF) of patients with heart failure
Results: A total of 969 (277 males and 692 with reduced ejection fraction (HFrEF) by com-
females) completed and returned the question- parison with 2D echocardiography (2DE), when
naire: 308 first year students; 454 fourth year stu- used by fellows with different levels of training in
dents; 207 sixth year of students. Four hundred 2DE and 3DE.
and thirty-two (44.6%) have smoked at least 100 Methods: Sixty patients with HFrEF (46 males,
cigarettes (5 packs) in their life. The mean age a 5817 years) underwent standard transthoracic
student begins smoking was 15.8 years. The most 2D acquisitions and 3D multi-beat full-volumes
important reasons for cigarette smoking were: de- of the left ventricle (LV), using Vingmed E9. One
crease of anxiety (51.4%), pleasure (48.8%) and expert in both 2DE and 3DE and 3 trainees (be-
habitude (43.7%). One hundred and forty six ginner, medium and expert) in 2DE measured the
(34%) need to light up a new cigarette after 1-3 2D LV volumes and LVEF, using the same con-
hours from the previous one. The study shows secutive images.

ABSTRACTS
After one-month training in 3DE, they mea- los (broadleaf spurge), E. stricta (upright spurge)
sured 3D LV volumes and LVEF, using 4D auto- and E. cyparissias (cypress spurge) on Methods:
LVQ, Echopac BT 12. All measurements were Extracts from aerial parts of the plant species were
compared with ones provided by the 3DE expert. prepared using green solvents. The cell lines
Results: Seven patients were excluded due to were exposed to four concentrations of plant ex-
poor quality images. Mean LV end-diastolic vol- tracts and MTT assay was performed on MCF7
ume (EDV) was 21475 ml with 2DE, and (breast cancer), Caco-2 (colon carcinoma) and
23377 ml with 3DE. Mean LVEF was 3510% HeLa (cervical cancer) human tumor cancer cell
by 2DE, and 3310% by 3DE. lines.
The trainees showed acceptable or good re- Results: The plant extracts from Euphorbia
producibility of the 2DE measurements, accord- species showed to have cytotoxic activity against
ing to their level of 2DE expertise (Table). How- MCF7 and Caco-2 cells in a dose-dependent
ever, after just one month training in 3DE, the manner, but not against HeLa cells. E. stricta ex-
trainees provided similar and more reproducible tract exhibited the highest activity on Caco-2 and
results of the LV volumes and EF measurements MCF7 cells, E. cyparissias on HeLa cells, whereas
(Table). E. platyphyllos on all tested cells.
Conclusions: 3D echocardiography is a fast- Conclusions: Euphorbia extracts display at
learning and more reproducible method com- least 50% cell death at 100 g/mL and therefore
pared with 2D echocardiography for the assess- are considered with anti-cancer potential. Further
ment of LV volumes and ejection fraction, studies of the active extracts are necessary in or-
regardless of the level of training in 2D echocar- der to establish the dose-response and the mech-
diography. This makes 3D echocardiography a anisms involved.
more reliable method for the follow-up of pa- Acknoledgements: The authors acknowledge
tients with heart failure with reduced ejection the financial support offered by UEFISCDI,
fraction. through PN-II-CT-RO-ZA-2014 grant, Romania
South Africa Joint Collaboration (project leader
PHARMACY Olaru O. T.).
(280) Antiproliferative (307) New Al(III), Ga(III)

assay of Euphorbia species and In(III) complexes as
extracts on human cancer metallodrug candidates:
cell lines synthesis, characterization
Octavian Tudorel Olaru1, Luanne and preliminary toxicity
Venables1, Georgiana Nitulescu1, Trevor evaluation
Koekemoer2, George Mihai Nitulescu2,
Alexandra-Cristina Ticea, Alexandru
Maryna Van de Venter2 Ciprian Chirita, Ionut Mihai Ionita,
1
University of Medicine and Pharmacy Carol Andreea Iordache, Ionut Bogdan
2
Voinicu, Octavian Tudorel Olaru,
Metropolitan University Nelson Mandela, Port
Elizabeth, South Africa Valentina Uivarosi
Objectives: Euphorbia genus belongs to the Davila, Bucharest, Romania
Euphorbiaceae family and contains plant species
spread all over the world. Regarding the chemical Objectives: The trivalent Group 13 metal
composition, these species are characterized by ions are non-essential elements for the human
the presence of triterpenoids, diterpenoids, flavo- body, but their complexes of biological interest
noids and lipids. Studies on flavonoids and other are known: aluminium complexes are suitable
compounds isolated from Euphorbia species re- compounds for toxicology and neuropathology
vealed anti-inflammatory, anti-malaria, anti-ure- with relevance to Alzheimers disease, gallium
ase, cytotoxic, apoptotic promoter and antiprolif- complexes are used as diagnostic radiopharma-
erative effects. In the present paper we assessed ceuticals for SPECT and PET imaging or as anti-
the cytotoxicity potential of some extracts ob- cancer agents, while 111indium complexes are
tained from three indigene species: E. platyphyl- widely used as radiopharmaceuticals for SPECT

ABSTRACTS
imaging. This study aimed to obtain new poten- oil extracted from the seeds of Acer negundo L.
tially bioactive complexes of Al(III), Ga(III) and (Box Elder) due to its composition rich in polyun-
In(III) with the naturally flavonoid 5-hydroxyfla- saturated fatty acids (-linolenic acid, stearidonic
vone and to evaluate their acute toxicity on the acid, -linolenic acid) that reduce the synthesis of
crustacean Daphnia magna. pro-inflammatory and algogenic eicosanoids and
Methods: The general method of synthesis increase the synthesis of anti-inflammatory and
consist in refluxing during 3 hours an alcoholic or analgesic eicosanoids.
hydro alcoholic solution containing the ligand Methods: The anti-inflammatory activity of
and the appropriate metal salt in a 3:1 molar ra- the fatty oil (10 mL/kg bw, orally) was evaluated
tio, with pH adjusted at 6-7, until a yellow pre- using the dextran-induced rat paw edema meth-
cipitate is formed. The complexes were charac- od. The activity of the oil was compared with that
terized by elemental analysis, ESIMS, IR, UVVis of phenylbutazone (100 mg/ kg bw, orally) and a
and fluorescence spectra, determination of molar control group, treated with distilled water. The
conductivity in DMSO (dimethyl sulfoxide), and analgesic effect was determined in mice, by
thermogravimetric analysis. Acute toxicity on means of hot-plate test and acetic acid induced
crustacean Daphnia magna was evaluated using writhing test. In both tests, the activity of the oil
three concentrations (510-5, 510-6 , 510-7 (10 mL/kg bw, orally) was compared with that of
M) both from starting materials and complexes, acetylsalicylic acid (100 mg/ kg bw, orally) and a
followed by the evaluation of median lethal dose, control group, treated with distilled water.
LD50 of the complexes. Results: Acer negundo fatty oil exhibits anti-
Results: The methods used for characteriza- inflammatory effect when compared with the
tion allowed us to establish the composition and control group, with a maximum effect at 80 min
the structure of the obtained compounds, which after the administration of dextran. Compared
correspond to the general formula ML3 x nH2O with phenylbutazone, the anti-inflammatory ef-
(M: Al(III), n=2; M: Ga(III), n=1; M: In(III), n=1; fect of Acer negundo oil is lower. In the hot-plate
L = deprotonated 5-hydroxyflavone), with 5-hy- test Acer negundo oil exhibits analgesic effect
droxyflavone acting as an monoanionic bidentate when compared with the control group (38.08%)
ligand. Toxicity studies on Daphnia magna evi- and also when compared with the group treated
denced the low toxicity of the obtained complex- with acetylsalicylic acid. The results are statisti-
es. cally significant only in the first case. In the acetic
Conclusions: The study led to the synthesis of acid induced writhing test, the animals treated
three new complex compounds of Al(III), Ga(III), the fatty oil experienced fewer contortions than
In(III) with 5-hydroxyflavone, with low toxicity, the control group, but more than those treated
suitable for further determinations of biological with acetylsalicylic acid.
activity. Conclusions: From these results we can con-
clude that the fatty oil extracted from the seeds of
Acer negundo L. exhibits anti-inflammatory and
(265) Pharmacological analgesic effects and it can be used as a comple-
research regarding the anti- mentary treatment for pain associated with sev-
eral inflammatory conditions.
inflammatory and analgesic
effects of the fatty oil (22) Red raspberry leaves
extracted from the seeds of a source of natural
Acer negundo L compounds with
Oana Cristina Seremet1, antioxidant activity
Simona Negres1, Mihaela Dinu2,
Teodora Costea, Cerasela Elena Gird,
Marilena Viorica Hovanet1
Maria Lidia Popescu, Ligia Elena Dutu,
1
University of Medicine and Pharmacy Carol Ioana Nencu
1
2
Department of Pharmacology and Clinical University of Medicine and Pharmacy Carol
Pharmacy, University of Medicine and Pharmacy Davila, Bucharest, Romania
Carol Davila, Bucharest, Romania
The role of oxidative stress and free-radicals
Objectives: In this paper we investigated the mechanisms in the pathology of multiple diseases
anti-inflammatory and analgesic effect of the fatty (diabetes mellitus, cancer, stroke, non-alchoholic

ABSTRACTS
fatty liver, Alzheimer, Parkinson) has become an (386) Study of Clopidogrel

area of intense interest.
Objectives: The aim of our study was the de- in vitro release kinetics
termination of chemical composition and antioxi- using different biorelevant
dant activity of indigenous red raspberry leaves
(Rubi idaei folium).
test setups
Methods: Red raspberry leaves were collected Valentina Anuta, Mihaela Violeta Ghica,
in May 2012 from a private garden (Ilfov county, Lacramioara Popa, Cristina Dinu-Parvu
Romania), air-dried and stored in laboratory con-
ditions. The chemical composition was deter- University of Medicine and Pharmacy Carol
mined by means of thin layer chromatography Davila, Bucharest
(TLC), high liquid chromatography (HPLC) and
spectrophotometric methods. Using spectropho- Objectives: Present study evaluates the re-
tometric assays we have determined the content lease kinetics of the BCS Class II antiplatelet agent
of total polyphenols (g% gallic acid), flavonoids clopidogrel from different commercial immediate
(g% hyperoside), phenolcarboxylic acids (g% release formulations, using two different ap-
chlorogenic acids), tannins (g% pyrogallol), pro- proaches: a classical approach, using the USP
anthocyanidins (g% cyanidin chloride) and free/ compendial media simulating the gastric and in-
hydrolysed/esterified sterols (g% stigmasterol). testinal environment, and a biorelevant one,
The scavenger activity against 2.2-diphenyl- simulating gastric and intestinal conditions of the
1-picrylhydrazyl (DPPH) free radical and the re- fasted and fed state with media containing physi-
ducing power were used for antioxidant activity ological surface active agents (sodium taurocho-
evaluation. The EC50 (mg/mL), which represents late, lecithin). In order to better reflect the physi-
the herbal product concentration that reduces cochemical and hydrodynamic conditions that
DPPH free radical activity by 50% or the concen- are likely to prevail during the in vivo dissolution-
tration for which the absorbance was 0.5 (for re- absorption process, a biphasic dissolution test
ducing power method) was compared to that of was also developed and tested.
well-known antioxidants (ascorbic acid, catechin, Methods: Drug release experiments were
gallic acid and hyperoside). performed with USP Apparatus 2 (Paddle), at 50
Results: TLC analysis revealed the presence rpm.
of chlorogenic acid, rutin, stigmasterol, ursolic The compendial dissolution media used for
acid/ oleanolic acid in red raspberry leaves. Ac- clopidogrel release kinetics evaluation consisted
cording to our HPLC results Rubi idaei folium are in the followings: Simulated Gastric Fluid (pH
an important source of: hyperoside (0.26 g %), 1.2) and Simulated Intestinal Fluid (pH 6.8 buf-
quercitroside (0.25 g%), quercetin (96.0 mg%) fer). A set of four biorelevant media, proved in
and kaempferol (94.6 mg%). Using HPLC we the literature to be representative for the fasted
have also identified rutin, caffeic acid, chlorogen- stomach (FaSSGF), the postprandial stomach
ic acid and ferulic acid. The spectrophotometric (FeSSGF), fasting state conditions in the small in-
assays revealed a considerable amount of flavo- testine (FaSSIF) and postprandial conditions in the
noids (1.33 g%), phenolcarboxylic acids (1.74 small intestine (FeSSIF) was also used. For the bi-
g%), tannins (9.88 g%) and sterols (0.81 g%); phasic in vitro test, the dissolution system con-
moreover a small content of pronthocyanidins sisted of an aqueous phase (FaSSIF, 500 mL) and
(0.05 g%) was also determined. The antioxidant octanol (250 mL). Quantitative analysis of Clopi-
activity (EC50 = 0.2886 mg/mL - DPPH method dogrel was performed using a validated HPLC
and 0.3754 mg/mL - reducing power assay) was method, with UV detection at 220 nm.
weak compared to that of standard references. Results: Results indicated a highly pH-depen-
Conclusions: Red raspberry leaves are an im- dent dissolution profile, with very rapid and com-
portant indigenous source of bioactive complete dissolution in gastric medium, followed by a
pounds that might be used for obtaining several significant tendency to precipitate towards the
extracts with antioxidant properties. higher pH of the intestinal media. Dissolution in
intestinal media was incomplete in both fed and
fasting conditions. Although bile salts were ex-
pected to increase solubility by the intermediate
of micelles, this result appeared to be significant
only under fed conditions (80% drug released
within two hours versus 60% under fasting condi-
tions).

ABSTRACTS
The plateau obtained in FaSSIF after about and the copper (II) complexes were screened for
45 minutes suggested saturation of the dissolution their antioxidant activity by free radical scaveng-
medium, whereas in the biphasic setup no satura- ing assays using 1,1-diphenyl-2-picrylhydrazyl
tion was observed. (DPPH) and 2,2-azino-bis(3-ethylbenzothiazo-
Conclusions: Experiments have led to results line-6-sulfonic acid) (ABTS) and compared with
that provide useful information on both the in that of butylated hydroxytoluene (BHT) and bu-
vivo release and absorption of clopidogrel, and tylated hydroxyanisole (BHA) standards.
provide some possible explanations on its high The physico-chemical analysis confirmed the
variability. newly structures of the ligand and the copper (II)
complexes. In the complexes 1, 3 and 4, HL1 acts
(143) Synthesis, crystal as a mononegative bidentate ligand coordinating
to the metal ion through the azomethine nitrogen
structure and biological and thiolato sulphur atoms. In complex 2 the li-
activity of Cu(II) complexes gand coordinates in a neutral bidentate manner.
The values of eff (1.76 - 1.94 MB) for complexes
with 1,5-bis(5-methyl-2- 1 4 suggest the presence of an unpaired elec-
furaldehyde) tron and indicates the existence of monomeric
thiocarbohydrazone species of copper (II). The EPR spectra of the
complexes 1 4 recorded on powder at 298 K
Diana-Carolina Ilies, Sergiu Shova, show signals with g (2,003 - 2,090) and g//
Elena Pahontu, Aurelian Gulea, (2,256 - 2,279) values which indicate that the
fundamental state is described by orbital. The
Tudor Rosu
copper (II) complexes exhibited better antimicro-
University of Medicine and Pharmacy Carol bial and antioxidant activities than those of the
Davila, Bucharest, Romania thiocarbohydrazone ligand.
Thiocarbohydrazones (R1R2C=NN(H)C(= SURGICAL SPECIALITIES

S)N(H)N=CR3R4) are an important group of
multidentate ligands and usually coordinate with
the metal through the imine nitrogen and sulfur
(342) Biopsy or debulking
atoms with a self-assembled multinuclear square for retroperitoneal tumors?
complex. Heterocyclic derivatives of thiocarbo-
hydrazone are attractive targets of research owing
Angela Madalina Lazar1,
to their presence in biological, pharmacological Dan Nicolae Straja2, Eugen Bratucu2
and other applications. 1
The ligand 1,5-bis(5-methyl-2-furaldehyde) Davila, Bucharest, Romania
thiocarbohydrazone (HL1) was synthesized thro- 2
First Surgical Clinic, Institute of Oncology
ugh condensation of 5-methyl-2-furaldehyde and Prof. Dr. Al. Trestioreanu, Bucharest, Romania
thiocarbohydrazide. Four copper(II) complexes
[Cu(L1)2] (1), [Cu(HL1)(SO4)(H2O)2] (2), [Cu(L1) Objectives: Retroperitoneal tumors represent
(NO3)(H2O)] (3), [Cu(L1)(ClO4)] (4) were synthe- a heterogeneous neoplastic group that often de-
sized using HL1 and different copper salts. The velops insidiously, with frequent dimensions of
thiocarbohydrazone ligand was characterized by more than 20 cm. However, their delayed diag-
elemental analysis, UV-Vis, FT-IR, 1H and 13C- nosis explains the frequent impossibility of achiev-
NMR spectral studies. The structures of the coping surgical interventions of curative radical in-
per (II) complexes have been proposed by ele- tent, with negative resection margins. Altogether,
mental analyses, molar conductance, spectral (IR, surgical radicality remains the only positive prog-
UV-Vis and EPR), magnetic and thermal studies. nostic factor that is unanimously recognized by
In addition, the structure of complex 1 was deter- authors. However, currently, there is no consen-
mined by single-crystal X-ray diffraction. The li- sus between medical centers regarding the prog-
gand HL1 and copper (II) complexes were tested nostic significance of other factors related to the
for their antibacterial activity against gram-posi- tumor, patient or of therapeutic nature and dis-
tive bacteria (Staphylococcus aureus ATCC 6538 putes persist even in concern with the degree of
and Enterococcus faecalis ATCC 29212), gram- aggressiveness required in the case of radical sur-
negative bacteria (Escherichia coli ATCC 8739 gical interventions. As the frequency of non-radi-
and Salmonella enteritidis ATCC 13076) and cal surgical interventions is however high, the aim
Candida albicans ATCC 10231. The free ligand of the current study was represented by the anal-

ABSTRACTS
ysis of the prognostic differences associated to necology Unit of the University Emergency Hos-
various types of non-radical operations. pital Bucharest leading to a ongoing prospective
Methods: We conducted a detailed study, study started in January 2015. The following ul-
over a period of 15 years, on a group of 160 pa- trasound aspect were taken into account and
tients with retroperitoneal tumors, operated on in evaluated : average endometrial thickening, en-
the First Surgical Clinic of Bucharest Institute of dometrial thickness uniformity, homogeneity and
Oncology Prof. Dr. Al. Trestioreanu. We ana- aspect, dilated glands presence ,disruption of en-
lyzed the types of surgical interventions achieved dometrial miometrial line, midline deformation,
for this group of patients and their frequency, the doppler aspect, tumor existence with shape as-
prognostic differences between various types of pect, hyperechoic line sign and free endometrial
non-radical surgical operations. fluid presence.
Results: In the current study, as well, the radi- Results: Starting from a number of 35 patients
cality of surgical interventions represents the main evaluated for endometrial pathology, 20% (N=7)
positive prognostic factor for the operated on pa- were considered judging by ultrasound criteria to
tients. No significant differences between the pa- be polyps, the remainder of 80% branching out
tients that underwent different types of non-radi- into fibromas (5%, N=2), and endometrial thick-
cal surgical interventions (biopsy versus debulking) ening (75%, N=26). The average endometrial
could be observed, although these have associat- thickness ranged from 13.45 mm for premeno-
ed in exchange more frequently intra- and post- pausal women to 8.2 mm for postmenopausal
operative complications of negative impact on ones. 77% of patients experienced regular thick-
the immediate and long-term survival of the opening with echogenic aspect in 94% of cases and
erated patients. homogeneity of 83%. Dilated glandular aspects
Conclusions: As radical surgical interventions were detected in 9% of patients and with midline
can be achieved only in a relatively limited per- deformation for 20%. A single feeding artery was
cent of patients (approximately 50%), it becomes seen in 54% of cases despite a tumor existence of
essential the establishment of an optimal attitude 50%, 49% out of which being of oval shape. The
when the intraoperative finding of impossibility in hyperechoic line sign was present in 34% of cases
achieving a surgical resection of curative intent is and free fluid in 6% respectively. The histology
made. The appearance of therapeutic gain aspects rendered a higher number of polyps of
when achieving a surgical intervention of cytore- about 35%, the extra 15% of cases having been
ductive type in comparison with a simple tumor previously mistaken for endometrial thickening.
biopsy is however not sustained by the ensuing Conclusions: The ultrasound aspect of endo-
results and should probably be discouraged, to metrial polyps is a method of diagnosis worth to
decrease the rate of postoperative complications be taken into account but it is not fail proof de-
as well. spite its high rate of predictability. Pathology is
considered gold standard as it is necessary for his-
(300) Endometrial polyps, tological anomaly detection.
diagnostic aspects
(366) Multidisciplinary
Irina-Adriana Horhoianu, approach in collective
Vasile-Valerica Horhoianu, Corina
burn patients
Grigoriu, Gabriel Radu, Monica Cirstoiu
University of Medicine and Pharmacy Carol Andrei Porosnicu1, Andrea Anghel2,
Davila, Bucharest, Romania Iulia Spiridon1, Ruxandra Sinescu2
1
Emergency University Hospital Elias, Bucharest,
Objectives: Endometrial thickening repre- Romania
sents a heterogeneous group with definitions in- 2
duced by age and with a diagnosis and outcome Davila, Bucharest, Romania
depending on ultrasound and pathology. We are
interested in researching the ultrasound aspects Introduction: Burn injury represents the most
leading to the diagnosis of polyps and comparing severe kind of trauma for the human body. The
them to the pathology results. prognosis in burn patients depends on the total
Methods: The necessary information was body surface area (TBSA), the burn depth and the
gathered from the data sheets and pathology re- presence of inhalation injury. At the same time,
sults of patients treated in the Obstetrics and Gy- the number of simultaneous severe burn victims

ABSTRACTS
is another prognosis factor. There are a lot of ad- (343) Restoring normal ACL
vances in burn care, but the treatment of this
complex condition requires a multidisciplinary anatomy through
burn team that can improve the survival rate and reconstruction using the
the quality of life.
Objectives: This study aims to share our ex-
outside-in femoral tunnel
perience with multiple burn patients, all victims drilling technique with
in a collective accident, an inside fire in Colec- arthroscopic confirmation
tiv club.
Methods: We treated 16 patients with TBSA of tunnel positioning early
burn injury spanning between 8% and 60%, all of results
them presenting signs of smoke inhalation on the
upper airway. We adhered to the strictest rules of Bogdan Sendrea1, Stefan Mogos2,
asepsy and antisepsy from the beginning.12 pa- George Viscopoleanu1, Radu Orfanu2,
tients with more than 20% TBSA burns were ad- Ioan Cristian Stoica1
mitted in the intensive care unit, fluid rehabilita- 1
tion being immediately started; all of these Hospital Foisor, Bucharest, Romania
2
patients also necessitated emergency escharoto- University of Medicine and Pharmacy Carol
my incisions on the upper limbs. 8 patients re- Davila, Bucharest, Romania
quired orotracheal intubation during the first
hours from admission. Objective: Femoral tunnel drilling in anterior
All the patients were treated with daily wound cruciate ligament (ACL) reconstruction has been
lavage with antiseptic solutions and sterile dress- incriminated for decreased clinical results postop-
ings with local antimicrobial agents (silver sulfa- eratively. The objective of the current study was
diazine), early necrotic tissue excision and split to evaluate the results of ACL reconstruction us-
skin thickness grafting and early rehabilitation. ing the outside-in femoral tunnel drilling tech-
The rates of wound contamination and infection nique with arthroscopic confirmation of tunnel
with multi-resistant germs were similar to those positioning. The hypothesis was that this surgical
reported internationally. All the patients benefit- technique improves clinical outcomes compared
ed of continous professional psychological sup- to the preoperative evaluation.
port. Bronchoscopy and aspiration were per- Methods: The study group included 52 pa-
formed regularly in intensive care patients, with tients who underwent ACL reconstruction using
tracheostomy for those patients that required the outside-in femoral tunnel drilling technique
long-term intubation. One patient developed ab- with arthroscopic confirmation of tunnel posi-
dominal compartment syndrome that was treated tioning between 01.04-01.12.2014. The group,
with laparoscopy surgery. composed of 30 males and 22 females, with a
Results: A large spectrum of medical and sur- mean age of 28 years. Preoperative and postop-
gical specialties were involved in the manage- erative (12 months follow-up) clinical parameters
ment of these severely burnt patients, but, with (the Lachman and pivot shift tests, differential lax-
considerable human and material effort, all the ity measurement using the Rolimeter arthrometer,
patients survived. Lysholm Score, IKDC subjective and objective
Conclusions: In burn patients, good survival scores, and Tegner activity scale) of the group
rates and satisfactory rehabilitation perspectives have been recorded and analyzed.
are possible with a sustained effort and a multidis- Results: The postoperative data proved con-
ciplinary team approach. sistent with a favourable evolution, in comparison
with preoperative score values. All patients had
positive preoperative Lachman (13 grade I, 31
grade II and 8 grade III). Postoperatively, 4 pa-
tients had positive grade I Lachman test. Pivot
shift was grade I positive in 9 patients at follow-up
compared to 50 patients pre-operatively. The av-
erage Rolimeter differential laxity improved from
6.63 mm pre-operatively to 1.67 mm post-oper-
atively. Mean Lysholm score improved postopera-
tively to 92.83 from the preoperative value of
73.5.

ABSTRACTS
The average subjective IKDC score increased diagnosed with true knot of the umbilical cord. 7
from 73.44 to 91.77 at follow-up. Postoperative of these were diagnosed prenatal by ultrasound
Objective IKDC included 47 patients in groups A examination. 46 of these cases were delivered by
& B and 5 patients in group C & D compared to Caesarian section. The Apgar score was equal or
the preoperative 9 patients in group A & B and 43 higher than 8 in most cases (n=51), but in 5 cases
patients in group C & D. was less than 7, and in one particular case the
The Tegner activity score remained constant Apgar score was 1.
4 with 75% of the group retuning to the pre- Conclusions: Even though the prenatal iden-
injury level of activity. tification of a true umbilical knot is challenging
Conclusion: Outside-in femoral tunnel drill- and difficult, all ultrasound departments should
ing technique with arthroscopic confirmation of focus more on diagnose of this pathology.
tunnel positioning improves clinical outcomes by
restorating normal ACL anatomy. (87) Uterine artery
embolization the most
(274) True umbilical knot
effective method of
the experience of the
interventional treatment of
Department of Obstetrics
metrorrhagia in patients
and Gynecology of
with multiple uterine
University Emergency
fibroids
Bucharest Hospital
Octavian Munteanu1, Bogdan Dorobat2,
Gabriel Radu, Roxana Bohiltea,
Diana Voicu3, Oana Bodean3,
Octavian Munteanu, Diana Voicu,
Ruxandra Albu3,4, Roxana Bohiltea4,
Oana Bodean, Nicoleta Pruna, Irina
Monica Mihaela Cirstoiu3,4
Horhoianu, Monica Cirstoiu
1
Department of Anatomy, University of Medicine
Department of Obstetrics-Gynecology, and Pharmacy Carol Davila, Bucharest, Romania
Emergency University Hospital, Bucharest, 2
Department of Interventional Angiography,
Romania Emergency University Hospital, Bucharest,
Romania
Objectives: This study was undertaken in or- 3
Department of Obstetrics and Gynecology,
der to evaluate the incidence of true umbilical
knot between 01.01.2013 and 31.12.2015 in the
Romania
Department of Obstetrics and Gynecology of 4
Emergency University Hospital Bucharest and
also to analyze the modality of establishing the
diagnosis and the impact of this condition on the
Objective: This study was undertaken in or-
fetus and the way of delivery.
der to determine the effectiveness of uterine ar-
Methods: We conducted a retrospective
tery embolization in decreasing metrorrhagia in
study in which we included all the patients who
delivered in the Department of Obstetrics and patients diagnosed with multiple uterine fibroids.
Gynecology of Emergency University Hospital Methods: We retrospectively analyzed the
Bucharest between 01.01.2013 and 31.12.2015 medical records of all patients, diagnosed with
analyzing the number of patients diagnosed with multiple uterine fibroids in the Department of
true umbilical cord knot. We also evaluated how Obstetrics and Gynecology of Emergency Univer-
many of them were discovered prenatal and we sity Hospital of Bucharest between 01.01.2014
analyzed the technique of establishing the diag- and 31.12.2015, who underwent uterine artery
noses. All data was obtained from the patients embolization. All the patients were questioned
charts and the Department of Statistics of Emer- about metrorrhagia prior to and at a follow-up
gency University Hospital Bucharest. SPSS was visit in the first 3 months after the endovascular
used for statistical analysis. procedure. Data was obtained from medical re-
Results: Between 01.01.2013 and 31.12. cords and the Statistics Department of University
2015 10386 patients delivered in the Depart- Emergency Hospital in Bucharest. The statistical
ment of Obstetrics and Gynecology of Emergency analysis was performed using SPSS and Micro-
University Hospital Bucharest. 57 newborns were soft Excel 2010.

ABSTRACTS
Results: Between 01.01.2014 and

31.12.2015 298 patients underwent uterine ar-
tery embolization for multiple uterine fibroids.
The mean age in the group of patients analyzed
was 38.4 years. 67.45 % of the patients enrolled
in this study (n=201) affirmed an important de-
crease or the absence of abnormal uterine bleed-
ing in the first 3 months after the procedure.
Conclusion: We conclude that uterine artery
embolization is an effective minim-invasive pro-
cedure for the treatment of metrorrhagia in pa-
tients diagnosed with multiple uterine fibroids.

P RECLINICAL S PECIALITIES
(9) H-type rectovestibular (40) A cross-sectional survey

fistula: a rare entity in the among Romanian pregnant
spectrum of anorectal women regarding attitudes
malformations and knowledge about
Cristina Ghita1, Radu-Iulian Spataru2, rubella
Dan-Alexandru Iozsa2 Adelina Silvana Gheorghe1, Gabriela
1
University of Medicine and Pharmacy Carol Loredana Popa1, Andreia Florina Nita2,
Davila, Bucharest, Romania Madalina Preda1, Mihaela Roxana
2
Emergency Hospital for Children Regina Maria, Huhu3, Octavian Costin Ioghen1,
Bucharest, Romania
Mircea Ioan Popa2
Objective: We report a case of a congenital 1
rectovestibular fistula with normal anal opening Davila, Bucharest, Romania
successfully treated in a sagittal anterior approach 2
FP7-SCIENCE-IN-SOCIETY-2013-1
and fistula excision. H-type rectovestibular fistu- 3
Clinical Hospital Colentina (CDPC), Bucharest,
las are a rare situation in the wide spectrum of Romania
anorectal malformations. There are various surgi-
cal procedures suggested for this pathology, in- Background: Rubella virus, one of the patho-
cluding simple fistula resection and extensive gens causing the TORCH syndrome, is still preva-
perineal dissection. However, the frequency of lent in Romania, disregarding immunization pro-
postoperative fistula recurrence lays between 5% grams. In 2013 and 2014, 84 suspect cases of
and 30%. congenital rubella have been reported by the Na-
Method: An infant with polymalformative tional Institute of Public Health, some of them
syndrome, microcephaly is admitted in our unit leading to death. Therefore, this thread to the
for vulvar edema and perianal hyperemia associ- public health should be better analyzed, in terms
ated with superficial ulcers. The diagnosis of H- of causes and possible solutions. At the moment,
type rectovestibular fistula was considered after
there is not any national study regarding rubella
clinical examination. We considered a three-
awareness, in order to determine the current sta-
stage surgical treatment due to the delayed pre-
tus and apply the best further strategies.
sentation of the patient associating massive skin
Methods: We created a survey consisting in
injury.
35 questions with predefined answers in order to
Results: The outcome is very good with no
assess awareness and knowledge of rubella in Ro-
recurrence of the fistula 1 year after fistula exci-
sion by sagittal anterior approach. manian pregnant women. We collected data
Conclusion: The diagnosis for H-type rec- from 350 participants, from both rural and urban
tovestivular fistula needs to be given after a thor- areas, after receiving their written consent (from
ough clinical examination of the patient. Due to March 2013 until February 2015). We continue
its associated complications, a multi-stage treat- to apply the questionnaire, in order to meet an
ment is preferred. acceptable national coverage. Statistical analysis
was performed using Epi Info (version 7).
Results: Upon a preliminary assessment, the
vast majority of the surveyed women have heard
about rubella, but more than half of them were
not aware neither of the risk of transmission dur-
ing pregnancy and its potential effects, nor of the
symptoms of the infection. Two thirds of the re-
spondents knew about the causative agent of the
disease, but more than 60% believed that con-
genital rubella can be efficiently prevented with-
out vaccination. Less than half admitted to apply

ABSTRACTS
protection methods against airborne diseases (59) Abrikossoff tumor

(such as rubella). Moreover, a small percent of the
participants think that rubella can be caused by a rare presentation of
the anti-rubella vaccine. The rate of asking health- granular cell nerve sheath
care providers for information about rubella is
very low before pregnancy, but also during it.
tumor
Conclusions: There is a need for health edu- Mihnea-Calin-Mihu Dragostin,
cation programs related to pregnancy, provided Smaranda Doaga Sorana Petrescu,
both by doctors and governmental institutions.
Our study suggests that low adherence to preven-
Ionut-Codrin-Gheorghe Hogea,
tive acts and unstable knowledge of the risks as- Laurian-Mihai Niculescu,
sociated to rubella may influence in a negative Tiberiu-Augustin Georgescu,
way the perinatal outcome. Maria Sajin Mariana Costache
(51) The anatomic variants Davila, Bucharest, Romania
of the coeliac trunck and
Objective: Granular cell tumor (GCT) also
the clinical importance known as granular cell nerve sheath tumor, gran-
Iulia Madalina Staicu, Adrian Tulina ular cell schwannoma or Abrikossoff tumor is a
rare soft tissue neoplasm of neuroectodermal ori-
University of Medicine and Pharmacy Carol gin, first described by Abrikossoff in 1926. It af-
Davila, Bucharest, Romania fects mainly adults (age 30-60),but may occur at
any age, with a predilection for females and Afri-
Objective: The knowledge of the anatomy of can Americans. It appears as a superficial, usually
the coeliac trunck may be important during inva- benign, solitary, slow-growing tumor occurring
sive procedures like chemotherapy, angiography, mostly in the head and neck area, specifically the
chemoembolization and other surgical conditions tongue (40%). Congenital presentation, as well as
of the abdomen. This study has as main purpose an extremely rare and aggressive malignant form,
to present the anatomic variants in the vascular has also been reported in the scientific literature.
pattern of branches of the coeliac trunk in cadav- Association with neurofibromatosis is uncom-
ers for to prevent complication. mon.
Methods: Images with anatomical dissection Method: We report the case of a 56-year-old
in cadavers of the coeliac trunk and the study female presenting to the Department of Plastic
about this. Dissection included surgical incision, Surgery of the University Emergency Hospital Bu-
followed by mobilization of the anatomical vis- charest with a 3.5/2/1 cm skin-colored, firm nod-
cera, to observe and record the branching pattern ule located on the posterior thorax, which first
of the coeliac trunk. appeared several months ago as a small papule.
Results: The anatomic variants of the coeliac The nodule was surgically removed and sent to
trunck was expose and it found 3 types: the left the Department of Pathology in the same clinic
gastric, common hepatic and splenic arteries for histopathological evaluation.
were found to arise from the coeliac trunk; was Results: Histopathological examination re-
the origin of the gastric artery was proximal to the vealed a non-encapsulated tumor mass located in
bifurcation of the coeliac trunk into the common the dermis and subcutaneous tissue, with pink-
hepatic and splenic arteries or all three branches yellow cut-surface and finely granular appear-
arose directly from the abdominal aorta. ance, composed of irregularly arranged clusters of
Conclusion: A thorough knowledge of the large, round to oval cells with indistinct cell bor-
different vascular patterns of branches of the co- ders, brightly eosinophilic granular cytoplasm,
eliac trunk is vital for radiological imaging in the small, uniform, round to oval, centrally located
upper abdomen, because this could facilitate nuclei and inconspicuous mitotic activity. The
more accurate radiological interpretations. Al- granules were PAS-positive and formed larger
though it is important in surgical procedures like masses, surrounded by a clear halo, which are re-
liver transplantation and splenectomy, because ferred in the scientific literature to as the pustulo-
the complication like bleeding or necrosis may be ovoid bodies of Milan. As a result, the histopath-
minimize. ological diagnosis of benign granular cell tumor
(Abrikossoff tumor) was established and con-
firmed by immunohistochemical staining. The

ABSTRACTS
overlying epidermis was normal and did not show caldesmon, Leu7, desmin and S100.
pseudoepitheliomatous hyperplasia, which is a Conclusion: Clear cell sarcoma of the toe is
rather common finding in association with GCT. an extremely rare diagnosis with a poor prognosis
Conclusion: We consider this case particu- because of relapse and metastasis high-risk.
larly interesting because of its unusual presenta-
tion on the posterior thorax. Due to the potential (74) Fulminant evolution
for recurrence and morphologic overlap between
benign and malignant GCT, we emphasize the ut- in a case of advanced acral
most importance of complete tumor resection melanoma
followed by a thorough immunohistopathological
examination, in order to establish an accurate di- Ionut Codrin Gheorghe Hogea, Laurian
agnosis and ensure the best possible outcome for Mihai Niculescu, Ana Maria Dumitrescu,
the patient. Smaranda Doaga, Sorana Petrescu,
Tiberiu Augustin Georgescu, Adrian
(72) An interesting case Dumitru, Maria Sajin, Mariana Costache
of aggressive clear cell University of Medicine and Pharmacy Carol
sarcoma of the toe with Davila, Bucharest, Romania
lung metastasis Objective: Melanoma is an aggressive and
Luminita Elena Mitrache1, highly metastatic disease responsible for 1% to
George Simion2, Maria Sajin3 2% of all cancer deaths around the world which
usually affects adults and elderly patients, with a
1
Urology Clinical Hospital Prof. Dr. Th Burghele, peak incidence around the sixth decade of life.
Bucharest, Romania Acral melanoma is the fourth most common form
2
University of Medicine and Pharmacy Carol of cutaneous melanoma, often diagnosed late in
Davila, Bucharest, Romania its evolution. Metastatic spread may become clin-
3
Emergency University Hospital, Bucharest, ically evident during follow-up visits several years
Romania after excision of the primary tumor.
Method: We report the case of a 66-year-old
Background: Clear cell sarcoma of the toe is a male presenting to the Department of Plastic Sur-
very rare malignant soft tisuue tumor with un- gery of the University Emergency Hospital Bucha-
known histogenesis. A case report of a 49 years rest with an ulcerated nodule of 13/15/4 mm, lo-
old male patient is presented. cated on his right sole. The mass was surgically
Method: Surgical specimen was grossly exam- removed and sent to the Department of Patholo-
ined and processed in the pathology department. gy in the same clinic for histopathological evalua-
Hematoxylin eosin and van Gieson colored slides tion.
were examined under the microscope. For im- Results: A thorough microscopic examination
munohistochemistry tests CK19, calretinin, calde- of the specimen established the diagnosis of nod-
smon, actin, Leu7, desmin, HMB45 and S100 ular-type melanoma with invasion of the reticular
markers were used. dermis (Clarks level IV), a Breslow thickness of
Results: The patient presented to the hospital 7.1 mm and negative margins. The tumor fea-
for an infected hematoma of the first left toe fol- tured 21 mitotic figures per square millimeter,
lowing a local trauma. Presumably infected tissue microscopic satellites, increased angiogenesis, no
is resected. Histopathology exam reveals a malig- lymphovascular or perineural involvement as well
nant neoplastic proliferation consisting in short as no tumor-infiltrating lymphocytes and no areas
fascicles of spindle cells with eosinophilic and of regression. Positive immunostaining for HMB-
clear cytoplasm. Therefore, surgical resection of 45, S-100 and vimentin confirmed the diagnosis.
the tumor with resection margins is performed. The patient returned to our clinic 5 times in the
The tumor was white-yellow, infiltrative with a following 9 months with several firm nodules
maximum diameter of 6 cm. The tumor devel- scattered on the left calf and thigh, along the tra-
oped from the subcutaneous tissue and invaded jectory of the great saphenous vein. These nod-
soft tissue and bone structures of the foot. Also, ules were diagnosed as cutaneous and subcuta-
the tumor relapsed in a short period of time and neous metastases varying in size from 1 to 5 cm
CT exam revealed lung metastasis.On immuno- and involving the inner layers of the skin as well
histochemistry, neoplastic cells were positive for as the underlying muscular tissue.
actin, HMB-45 and negative for CK19, calretinin,

ABSTRACTS
Conclusion: Given the increased risk for me- partment of Pathology in the same hospital unit
tastasis and high mortality rates associated with for histopathological evaluation.
this malignancy, we emphasize the importance of Results: Gross examination of the specimen
maintaining a high level of suspicion for all types revealed a relatively well-defined yellowish-grey
of melanoma. Moreover, we strongly believe that intramural tumoral mass of 8/7/7 cm. The cut sur-
a comprehensive pathologic assessment of all tu- face of the tumor was soft, bulging and diffusely
mor parameters is essential not only because it hemorrhagic, presenting several small and irregu-
ensures an accurate prognostic estimation and lar cystic degenerated spaces filled with serous
appropriate clinical management, but because it fluid. Microscopically, the tumor was composed
may also illuminate the path for future research of round to polygonal cells, with central nuclei
regarding novel molecular therapeutic targets. and abundant clear to eosinophillic cytoplasm,
growing diffusely in sheets or nests, interspersed
(77) Epithelioid with focal spindle cells. Although nuclear pleo-
morphism was rather mild, the tumor featured 9
leiomyosarcoma of the mitotic figures per 10 HPF and extensive areas of
uterine corpus an coagulative necrosis and myxoid degeneration.
Immunohistochemical study included SMA, des-
immunohistochemical study min, vimentin, AE1/AE3 pan-cytokeratin, CD10,
with unexpected results ER, p53, HMB-45, S-100 and Ki-67. Except vi-
mentin, immunohistochemistry as well as histol-
Alexandru-Stefan Baicoianu, ogy supported the final diagnosis of epithelioid
Livia-Cristiana Nitescu, Andrei Manu, leiomyosarcoma, stage pT1bNxMx.
Maria-Ilinca Iosub, Mihnea-Calin-Mihu Conclusion: We were intrigued by the lack of
Dragostin, Anca Mihaela Lazaroiu, vimentin expression and we consider this particu-
lar case may represent a rare immunophenotypic
Maria Sajin, Adrian Dumitru,
variant of epithelioid leiomyosarcoma. We antici-
Tiberiu Augustin Georgescu pate that our finding may aid future studies in es-
University of Medicine and Pharmacy Carol tablishing the oncogenic mechanisms underlying
Davila, Bucharest, Romania the development of this elusive malignancy.
Objective: Leiomyosarcoma is the most com- (78) Immunohistopathologi-

mon variant of pure uterine sarcoma, accounting
for 1-2% of all uterine malignancies. Epithelioid cal analysis of endometrial
leiomyosarcoma is an uncommon histologic sub- clear cell carcinoma in a
type of leiomyosarcoma which lacks the severe
cytologic atypia and high mitotic index of the
hospital-based series of
typical spindle-shaped leiomyosarcoma. Preop- cases
erative distinction between leiomyoma and leio-
myosarcoma of the uterine corpus may be ex-
Andrei Manu, Maria-Ilinca Iosub,
tremely difficult, especially since their main signs Alexandru-Stefan Baicoianu,
and symptoms (abnormal vaginal bleeding, pal- Livia-Cristiana Nitescu,
pable pelvic mass, pelvic pain) are practically Ana-Maria Dumitrescu,
identical. Malignancy should always be taken into Anca Mihaela Lazaroiu, Maria Sajin,
consideration when identifying tumor growths in
menopausal women who are not on hormone re-
Tiberiu Augustin Georgescu
placement therapy. University of Medicine and Pharmacy Carol
Method: We report the case of a 68-year-old Davila, Bucharest, Romania
multiparous female, presenting to the Depart-
ment of Obstetrics-Gynecology of the University Objective: Endometrial clear cell carcinoma
Emergency Hospital Bucharest with abnormal is a rare subset of type II endometrial carcinoma
vaginal bleeding. Transabdominal ultrasound re- featuring an aggressive clinical behavior and high
vealed an intramural concentric, solid, hypoecho- propensity for early extra-uterine spread, with
ic mass displacing the echogenic endometrial less than 50% five-year survival rate, regardless of
stripe. The patient underwent a total hysterecto- stage.
my with bilateral salpingo-oophorectomy and the Method: In this retrospective analysis per-
surgically resected specimen was sent to the De- formed over the course of 1 year (January 2015 -

ABSTRACTS
January 2016), we reviewed 5 cases of endome- (94) How to use animal

trial clear cell carcinoma from the medical
database of the Department of Pathology of the models for human
Emergency University Hospital in Bucharest Ro- pathology study in the
mania. All patients were postmenopausal with a
mean age at presentation of 71 years and had no
spotlight: knockout mice
past history of long-term drug intake, hormone Ana-Maria Enciu1,2, Maria Dudau1,2,
replacement therapy, contraception, chemother- Ionela-Daniela Popescu2, Simona
apy or radiation exposure. All women presented
with postmenopausal bleeding and underwent
Mihai2, Elena Codrici2, Cristiana Tanase2
transvaginal ultrasound and endometrial biopsy 1
followed by radical hysterectomy with bilateral Davila, Bucharest, Romania
salpingo-oophorectomy and regional lymph node 2
National Institute of Pathology Victor Babes,
excision. Bucharest, Romania
Results: All cases were diagnosed in early
stages, with no lymph node involvement and no Fundamental research includes all methods
distant metastases. Three cases were limited to used to demonstrate a hypothesis or mechanism
the endometrium invading less than half of the using in vitro methods or animal models. There
myometrium (T1a), one invaded more than half are animal models, ranging from very simple or-
of the myometrium (T1b) and one invaded the ganisms, such as Saccharomyces cerevisae in
cervical stroma but did not extend beyond the mammals as close to the human body. Model
uterus (T2). Microscopic examination revealed complexity depends on the primary objective re-
large polyhedral and hobnail-shaped cells with search and interactions between various cellular
clear or eosinophilic cytoplasm, enlarged and an- and molecular systems to be included in the in-
gulated nuclei with irregular, prominent nucleoli, terpretation of results. Complex animal models
arranged in papillary, tubular or solid patterns can be further modified to emphasize the role of
with various degrees of nuclear atypia. Three out a single molecule in a cell type, a tissue or the
of the five cases also presented densely eosino- entire organism. A current practice for small
philic extracellular hyaline bodies. Immunohisto- mammals, such as mice laboratory, is the intro-
chemical studies revealed a high Ki-67 prolifera- duction of a human gene (transgenic mice) or
tion index, low immunoreactivity for p53 as well gene removal (knockout mice) at the level of a
as lack of estrogen (ER) and progesterone recep- single tissue or throughout the body, followed by
the study of induced changes. This paper aims to
tor (PR). Immunostaining was also performed for:
present the advantages and disadvantages of a
AE1/AE3 pan-cytokeratin, CK7, CK20, CA125,
knockout mouse model, exemplifying them with
CEA, WT1 and vimentin.
caveolin-1 knockout mouse model, as well as al-
Conclusion: Due to the lack of specific gross
ternatives for advancing the knowledge to human
and clinical features to distinguish endometrial
physiology and pathology.
clear cell carcinoma from other subtypes of endo-
Acknowledgment: This work was supported
metrial carcinoma, we emphasize the importance by CNCS- UEFISCDI, grant PN II-RU-TE-2014-4-
of a thorough immunohistopathological analysis 1531.
and comprehensive surgical staging in order to
establish an accurate diagnosis and facilitate adju-
vant treatment and surveillance.

ABSTRACTS
(97) GLA nonsense mutation (100) Positive and

(c.485G>A) in a three- differential imaging
generation family with diagnosis of Immune
Fabry disease Reconstitution
Gabriela Sarca1, Cristina Dragomir2, Inflammatory Syndrome
Adriana Stan2, Emilia Severin3 complicating Progressive
1
Hospital Professor C. Angelescu, Bucharest, Multifocal
Romania Leukoencephalopathy
2
Davila, Bucharest, Romania (IRIS-PML)
3
Genetic Lab, Bucharest, Romania Cristian Scheau1, Andreea-Elena
Background: GLA nonsense mutations seem Scheau2, Mihaly Enyedi1, Eugen Tarta-
to be associated with more severe clinical pheno- Arsene1, Catalina Ciornei1, Raluca
type. Papacocea2, Ioana Anca Badarau1
Main aims were to identify the disease-caus- 1
ing mutation, to screen high risk family members
and to predict the severity of clinical phenotype 2
Center of Diagnosis and Treatment Victor Babes,
and age of onset based on genotype-phenotype
Bucharest, Romania
analysis.
Methods: Seven family members were clini-
Objectives: To demonstrate the main imaging
cally assessed and enzyme activity levels were
features of Progressive Multifocal Leukoencepha-
evaluated as well. Genomic DNA was isolated
lopathy (PML). To define the criteria of Immune
from blood samples and analyzed for GLA gene
Reconstitution Inflammatory Syndrome (IRIS) as-
mutation.
sociated to PML. To present the main differential
Results: The proband, a 34-year-old man,
diagnosis of IRIS-PML in the setting of an immu-
was misdiagnosed for years. At 25 years of age he
nocompromised patient.
was diagnosed with Fabry disease. He had a less
Method: A number of 23 patients with HIV
severe phenotype failing to express cardiac, cere-
infection, diagnosed PML and progressively dete-
bral or renal symptoms. In addition, the patient
riorating neurological and clinical status while un-
presented a ventricular septal defect as an inci-
der antiretroviral therapy have been examined
dental finding which has not been reported previ-
between January 2013 and December 2015 on a
ously in Fabry disease. His maternal uncle had a
1.5T Magnetic Resonance Machine with a rou-
severe classic form and, in addition, osteonecro-
tine cerebral protocol including contrast media
sis of femoral head rarely reported as associated
administration. Imaging findings were followed
findings. All females were heterozygous; 3 of
according to the patients evolution and were
them were asymptomatic and 2 developed mild-
correlated with the clinical setting.
er symptoms, skin and heart predominantly af-
Results: Twelve of the patients were conclud-
fected. Fabry disease was caused by the presence
ed as being suffering from IRIS-PML after integrat-
of GLA nonsense mutation c.485G>A. All close
ing all their imaging, clinical and biological data
relatives of proband had one copy of the muta-
following the current standing guidelines. Several
tion.
imaging parameters were used as criteria for eval-
Conclusion: The family nonsense mutation
uating disease progression such as T2 hyper in-
c.485G>A known to predict the classic pheno-
tensity (overall signal intensity average), contrast
type showed a wide range of clinical manifesta-
enhancement, water diffusion restriction, mass
tions from severe to asymptomatic forms both in
effect and overall affected volume measurement.
males and females supporting the intrafamilial
Non-infectious demyelination, glioma and other
phenotypic variability for Fabrys disease.
central nervous system tumors were formally ex-
cluded. Other non-conventional MR modalities
like Magnetic Resonance Spectroscopy and Dif-
fusion Tensor Imaging are also discussed.
Conclusions: Immune Reconstitution Inflam-
matory Syndrome may be triggered by the onset

ABSTRACTS
of highly active anti-retroviral therapy in AIDS pa- lymphovascular or perineural invasion. The tu-
tients with low CD4 count, complicating progres- mor staging was pT3a.
sive multifocal leukoencephalopathy. Prognosis is Conclusions: This case report shows a malig-
poor in most cases, with neurological decline, nant melanoma with an important component of
seizures and ultimately, death. Correlation of clin- vertical growth phase, developed on preexisting
ical, biological and imaging features successfully melanocytic nevus. Most of the times, the benign
diagnoses the condition and, through quick and part is transformed into a malignant one, so that
proper diagnosis and prompt treatment may po- the nevus disappears, especially when the disease
tentially improve the patients prognosis. is advanced (being explained by the vertical
growth phase of melanoma). The particularity of
(103) Malignant melanoma this case is the association between the benign
component (melanocytic nevus) and the malig-
developed on preexisting nant one, considering the advanced stage of the
melanocytic nevus case tumor.
report
(113) Assessing osteoporosis
Angela-Stefania Varban1,
risk in young
Diana Costache1, Mariana Costache2
1
postmenopausal women
Department of Pathology, Emergency University
Hospital, Bucharest, Romania a well-chosen questionnaire
2
University of Medicine and Pharmacy Carol Elena Iuliana Pascu1,
Iustina Cosmina Mogos2
1
Objectives: Malignant melanoma is a type of Sanamed Hospital, Bucharest, Romania
2
cancer that originates from melanocytes at the University of Medicine and Pharmacy Carol
epidermal-dermal junction. The most important Davila, Bucharest, Romania
risk factors associated with this type of cancer are:
sunlight exposure (either intermittent or chronic) Objective: to develop a simple screening
and endogenous factors. tool, Self-Assessment Test for Osteoporosis (TAO),
Methods: A 71 year old male patient came to and compare it with the recommendations of the
the Plastic Surgery Department of the Emergency International Osteoporosis Federation (IOF) for
University Hospital in Bucharest for a pigmented bone mineral density (BMD) measure in women
tumor of the skin, located on the left scapular re- younger than 65-years.
gion. In the last three months, the tumor started Methods: A group of 47-women from
to grow and became itchy. Sanamed Hospital database was used to deter-
The surgeon performed a wide excision for mine the performance of these screening tools in
malignant lesions, due to its macroscopic appear- selecting subjects younger than 65-years-old for
ance (to include safety margin of healthy-look- BMD testing. All participants completed the
ing tissue). The cutaneous fragment was sent to questionnaire that included demographic and
the Pathology Department of the same hospital, risk factors for osteoporotic fractures of FRAX, in-
for further procedures and histopathological excluding BMD. The group was divided into two
amination. subgroups based on age as follows: age 65-years,
Results: Gross findings revealed a cutaneous respectively aged >65-years. We analyzed risk
fragment (68/57/25 mm) with an asymmetric pig- factors for osteoporosis and it was followed the
mented tumor (18/21 mm). The tumor had ir- model of Osteoporosis Tools for Asians
regular borders and different colors: black and Autoevaluation(OSTA) to develop a risk index by
whitish-grey areas. At the periphery of the tumor multiple linear regression analysis and we used
was an exophytic, sessile and amelanotic struc- values of this index to form an algorithm for iden-
ture. tification of women 65-years-old, who need
Microscopic findings revealed that the lesion BMD measurement. ROC curve and area under
was an invasive malignant melanoma developed the curve (AUC) compared the sensitivity/specif-
on preexisting melanocytic nevus, with no ulcer- ity analysis of this model with the recommenda-
ation. The tumor had both radial and vertical tions of the IOF.
growth phases. The Clark level of invasion was IV, Results: A total of 47-postmenopausal wom-
and the Breslow index was 2.7 mm. Also, two en were included and the index was derived from
atypical mitosis per mm2 were described, with no age and body weight based on the weighted

ABSTRACTS
share of each risk factor and selected threshold with active hemorrhage. The type of this surgical
value was set to-1. There are 25 (53.19%)-wom- procedure was atypical.
en whose index value is below-1 and whose The post operatory evolution was stationary,
risk of osteoporosis was 57.44% (27/47). AUC for without liver hemorrhage. Also, the patient need-
TAO and IOF were 0.738 (95%CI, 0.728-0.749, ed renal dialysis, but didnt respond to it and died
p<0.001) and 0.618 (95%CI, 0.606-0.630, 4 days later.
p<0.001). TAO sensitivity and specificity, for se- Results:
lected cutoff -1 and IOF to identify osteoporo- Macroscopy
sis were 72.1%; 64.0% and 77.6%; 45.6%. Partial resection of the left hepatic lobe mea-
Conclusions: The data presented may serve suring 8/5/4 cm with macroscopic aspect of mi-
to evidence-based approach to target testing cronodular and macronodular cirrhosis. Possible
BMD in women younger than 65 years in IOF tumor, measuring 4/0.5/0.4 cm.
treatment guidelines since the BMD measure- Microscopy
ments are not widely available in some communi- Solid type hepatocellular carcinoma. Low dif-
ties because of cost and lack of equipment. A ferentiated with high grade malignancy consisting
simple questionnaire can help identify women at of hepatocytes with marked nuclear pleomor-
high risk for BMD measurements, thus avoiding phism and numerous atypical mitosis. There are
the cost of measurement in women with low risk. numerous capillaries with carcinoma emboli.
Also, there are lesions associated with hepatic cir-
rhosis and microvesicular and macrovesicular ste-
(116) A case of solid-type atosis. There was no invasion of the round liga-
hepatocellular carcinoma ment and the surgical resection was complete.
associated with chronic C TNM classification was T2NxMx; Stage II
Conclusions: Hepatocellular carcinomas as-
hepatitis and cirrhosis sociated with virus C infection typically develop
after 20-30 years of infection, being preceded by
Mihaela Farcas, Andreea Iliesiu, Maria
liver cirrhosis. The particularities of our case were
Sajin, Radu Costea the following: female gender, <7 years infection
Emergency University Hospital, Bucharest, with hepatitis C virus, no alcohol and tobacco
Romania consumption. We have no data whether or not
the hepatocellular carcinoma arose in the settings
Objective: Hepatocellular carcinoma is the of HCV or other risk factors.
most common hepatobiliary malignancy that oc-
curs mostly in the liver containing hepatitis virus. (142) Fort and ford
The neoplastic transformation often results from
the accumulation of genetic changes during the evaluation in normal aging
repetitive cellular proliferation that occurs in the Mihnea-Alexandru Gaman,
damaged liver.
Amelia Maria Gaman
Methods: A 72-year-old woman was admit-
ted in our hospital with the following symptoms: University of Medicine and Pharmacy Carol
increased abdominal volume and diffuse abdom- Davila, Bucharest, Romania
inal pain, dyspnea and vomiting and weight loss. Objectives: The free radical theory of aging is
The symptoms were with recent debut. The pa- based on the increase of oxidative stress level
tient has been already diagnosed with viral C (SOx) which occurs with aging due to the oxidant-
hepatitis for 7 years, obesity, type II diabetes mel- prooxidant imbalance. This imbalance is caused
litus, hypertension, esophageal varices and nodu- by the rise in the production of reactive oxygen
lar goiter with hypothyroidism. We didnt identify species (ROS), the progressive decrease of the an-
history of smoking and alcohol abuse. tioxidant capacity, and the permanent exposure
The patient has been hospitalized and the CT- to prooxidant factors of environmental origin. An
examination reveals the following aspects: 56/53 important role is played by the mitochondrial ag-
mm hypodense expansive tissue with heteroge- ing process, as the level of ROS increases, where-
nous aspect. as the antioxidant synthesis decreases, both in an
In the same day was performed a surgical pro- age-dependent manner. Cell aging is the result of
cedure which revealed blood in the peritoneal an accumulation of ROS-induced subcellular le-
cavity of approximately 3 liters, micronodular sions at a protein/lipid level or in the DNA.
and macronodular liver cirrhosis and a 6 cm tu- Methods: We evaluated SOx in 20 subjects
mor located in the left hepatic lobe (III segment) (60 70 years old) that had an apparently healthy

ABSTRACTS
status, with a glycaemic and lipid profile and a oral squamous cell carcinomas and 14 volunteers
systolic blood pressure in conformity with their as control. IL-6 was detected using chemilumi-
age, and compared them to a control group of 20 nescence while TAC detection was performed us-
young subjects (20 30 years old), non-smokers, ing the TEAC method (Trolox Equivalent Antioxi-
with a normal body mass index. We evaluated dant Capacity).
the level of ROS by the FORT test and the total Results: Salivary IL-6 levels showed a signifi-
antioxidant capacity by the FORD test with a cant increase in the oral cancer group compared
CR3000 analyzer. A statistical analysis was per- to the control group (2.9 pg IL-6 / mg albumin
formed, a p-value less than 0.05 being consid- 0.4 vs. 0.8 pg IL-6 / mg albumin IL-6 0.07 ).
ered significant. Salivary TAC showed a significant decrease in the
Results and conclusions: The FORT test re- oral cancer group when compared to respective
vealed normal values in the control group and controls (0.62 mmol / mg albumin 0.12 vs.
moderately high values in the elder group. The 1.31 mmol / mg albumin 0.8 ). A statistically
FORD test depicted normal values in the control significant negative correlation was found be-
group and low values in the latter. Statistically sig- tween IL-6 and TAC levels.
nificant differences have been registered between Conclusions: The present study showed that
the two groups (p-value <0.05). The normal ag- IL-6 and TAC could be used in the future as bio-
ing process is associated with a progressive rise in markers in diagnosing and monitoring oral can-
the value of ROS, which may be caused by the cer.
electron leak induced by the deterioration of Re-
dOx enzymatic systems, and also due to the de-
crease in the antioxidant capacity of the organ- (150) The influence of
ism. haplotype HLA-A3/A11 in
evolution after HSCT
(145) Salivary biomarkers
Denisa Bratu1, Ileana Constantinescu1,
of oxidative stress and
Ana Moise2
inflammation: a new 1
diagnostic tool in oral Davila, Bucharest, Romania
cancer 2
Department of Haematology, Fundeni Clinical
Institute, Bucharest, Romania
Radu Radulescu, Alexandra Totan,
Daniela Miricescu, Bogdan Calenic, Background: It is known that some patients
Maria Greabu haplotypes are ligands for inhibitors and activa-
tors donors KIR allele in HSCT. The same haplo-
University of Medicine and Pharmacy Carol type can be protective again post HSCT compli-
Davila, Bucharest, Romania cation, like ligand or not.
Objectives: Haplotype HLA-A3/A11 is de-
Background: Saliva can be utilized as a diag- scribed in literature like ,,good haplotype. In this
nostic fluid for a number of oral affections includ- study, we try to demonstrate the influence of this
ing oral cancer due to the high number of bio- haplotype at patients with acute leukemia after
markers contained and the ease of sampling.
HSCT.
Oxidative stress (OS) and inflammation are im-
Methods: Eighteen pairs patients-donors are
portant factors in cancer development. Despite
evaluated: patients with acute leukemia, lympho-
new diagnostic tools, oral cancer incidence con-
blastic and non-lymphoblastic and their genoi-
tinues to grow. A key inflammatory factor is IL-6
dentics donors. Fifteen patients have HLA-A3/
regulating chronic inflammation, cell prolifera-
A11 haplotype. Following the impact of inhibitory
tion, bone invasiveness and apoptosis. OS can be
KIR3DL2 and activatory KIR2DS4 on survival and
generated by inflammatory cells. Total antioxi-
complication development, we proved the pro-
dant capacity (TAC) encompasses all salivary anti-
tective efect of HLA-A3/A11 haplotype. The
oxidant mechanisms and has an important signifi-
source of HSCT was PBSC. The method used was
cance in OS detection.
PCR-SSP (Innotrain DIAGNOSTIK GMBH, Dynal
Objective: Evaluation of the diagnostic po-
BIOTECH PEL-FREEZE). The complications like
tential of salivary biomarkers IL-6 and TAC in oral
graft versus host disease acute and chronic, re-
cancer.
lapse, TMA and the recovery with leucocytes and
Methods: The present study included 30 pa-
thrombocyte followed.
tients (ages between 40 and 65), diagnosed with

ABSTRACTS
Results: HLA-A3/A11 haplotype is protective source, proves us that some alleleles can influ-
for both types of leukemia, the patients survival is ence the complication like TMA, and early throm-
much better (56 month, comparative with 10 bocytes recovery.
month) with statistical significance (sig<0.05). Is
protective against relapse, TMA, cGVHD and leu- (207) Is the treponemal IgM
cocytes recovery, with statistical significance. Like
ligand for KIR2DS4 improve survival. Like ligand ELISA useful for the
for KIR3DL2, also improve survival, so ,,missing diagnosis of congenital
ligand, theory in this case is not confirmed.
Conclusion: Like ligand or not, HLA-A3/A11 syphilis?
improve survival and protect against most compli- Adrian Bancescu1, Gabriel Ionescu2,
cation at patients with acute leukemia and relat-
Dan Ionescu1
ed donors with 100% allele match.
1
(151) Study of few cytokines 2
National Institute for Research I. Cantacuzino,
genes polymorphism and Bucharest, Romania
evolution after HSCT
Objective: To highlight the importance of the
Denisa Bratu1, Ileana Constantinescu1, treponemal IgM ELISA for the diagnosis of con-
Ana Moise2 genital syphilis. It is known that the maternal
1
treponemal antibodies belonging to IgM class do
University of Medicine and Pharmacy Carol not cross the placenta. IgM are produced by fetus
Davila, Bucharest, Romania (newborn) only if fetal infection occurred.
2
Department of Haematology, Fundeni Clinical Methods: Serological testing was performed
Institute, Bucharest, Romania in 22 children of 0-2 years, born of VDRL and
TPHA positive mothers with treponemal infection
Objectives: Cytokines gene polymorphism is acquired before or during pregnancy for which
part of transplant immunology with strong impli- they received treatment or not. The following di-
cation in evolution and development of early and agnostic tests were used: VDRL and TPHA for
late complication. This remain an open and acute mothers; VDRL, TPHA and treponemal IgM ELI-
problem for study and discussion. SA for newborns and children.
Methods: We studied a lot of eighteen pairs, Results: Five children of 1-2 years were nega-
patients with acute leukemia, lymphoblastic and tive for VDRL, TPHA and IgM ELISA. The results
non-lymphoblasti, and their donors, for polymor- of these tests denied the diagnosis of congenital
phism genes of few cytokines. All related donors syphilis received at birth and which was based
and recipients had 100% HLA alleles match. The only on the positivity of VDRL and TPHA (due to
source of HSCT was PBSC. The following cyto- the antibodies of IgG class transferred passively
kines are observed: IL-1 pos 889, IL-1RA pos from mother). A child of one year and 14 new-
mspa1 11100, IFN pos 874, TGF1 codon 10, borns were positive for VDRL and TPHA, but
TNF pos 308, IL-6 pos 174, IL-10 pos 1082, IL- negative for IgM ELISA, suggesting the passive
10 pos 592. The method used was PCR-SSP (Dy- transfer of maternal IgG. However, 2 newborns
nal Genotyping SSP Kit). The complications like were positive for VDRL, TPHA and IgM ELISA,
graft versus host disease acute and chronic, re- which suggested an active treponemal infection.
lapse, TMA and the recovery with leucocytes and The diagnosis of congenital syphilis was de-
thrombocytes are followed. nied in 20 (including 14 newborns) of the 22 chil-
Results: IL-1 pos 889, absence of CC/TC, dren, based on treponemal IgM ELISA, while this
TNF- pos 308 GA/GA, absence of GG/GG, IL-10 infection was confirmed only for 2 children.
pos 1082 AA/AA are favorable for early recovery Conclusion: The treponemal IgM ELISA test is
with thrombocytes (<17 days) with statistical sig- required to distinguish between active congenital
nificance. IFN pos 874, absence of AT/AT are infection and passive transplacentar transfer of
protective again TMA.IL-10 pos 592 AA/CA are maternal non-IgM antibodies. It eliminates false
also favorable for thrombocytes recovery. No in- positive congenital syphilis diagnosis based only
fluence, with statistical significance, was estab- on positive VDRL and TPHA serology, common
lished in our study. to mother and newborn.
Conclusions: A study like this, a small num-
ber of pairs, genoidentical, with PBSC like HSCT

ABSTRACTS
(214) Burnout levels of (216) Functional inter-

hemodialysis nurses relations in neurovascular
Iustina Diacon, Dumitra Marita coupling in cerebral cortex
University of Medicine and Pharmacy Carol Angela Madalina Lazar1, Leon Zagrean2
Burnout syndrome is a complex phenomenon 2
Discipline of Physiology and Fundamental
related to a stressful working environment, is a Neuroscience, University of Medicine and
syndrome that can be due to emotional exhaus- Pharmacy Carol Davila, Bucharest, Romania
tion, depersonalization and decreased personal
accomplishment. Providing care for patients with Objectives: Adequate blood delivery of oxy-
chronic disease such as end-stage renal disease, gen and glucose to cerebral parenchyma, charac-
working in a technical environment exactly of terized by an extremely increased metabolism, is
machines and coping with the increased expecta- capital for optimal neuronal functioning. The
tions of patients is stressful. coupling, in a complex of finely regulated interac-
Objectives: The purpose of this study was to tions, between neurons, astrocytes, interneurons,
determine the burnout levels of nurses working in arterioles and parenchymal capillaries, known as
hemodialysis units. neurovascular unit, ensures a blood flow that is
Methods: Data were collected by means of proportional to neuronal activity in space and
the Maslach Burnout Inventory .40 nurses with time. The current work aims to synthetize recent
more than 15 years of work experience complet- data that are sometimes contradictory, regarding
ed the questionnaires.The Maslach Burnout In- signaling mechanisms in neuronal-glial-vascular
ventory was used to assess levels of hemodialysis unit. A correct understanding of signaling is a pre-
nurses burnout. The inventory is a 22-item mea- requisite for efficient therapeutic solving of dys-
sure that assesses the frequency of occurrence of functions in cortical microcirculation.
three aspects of burnout: emotional exhaustion, Methods: Several modern applications for
depersonalization, and personal accomplish- graphical representation and visualization of
ment. complex networks, interpreted from the perspec-
Results: The results of the study revealed that tive of recent research works (2013-2016) have
nurses working in hemodialysis units experience been employed in order to identify putative inter-
a medium-level burnout in terms of subscales of relations that deserve an experimental confirma-
emotional exhaustion, depersonalization, and a tion.
high-level burnout in terms of the subscale of per- Results: By releasing neurotransmitters, neu-
sonal accomplishment. ronal synaptic transmission signal will determine
Conclusion: It is important to monitoring a calcium wave in astrocyte processes that will
burnout level, in order to recognize susceptible cause the release of vasoactive factors (K+, EET,
subjects and implement timely organizational PgE2) from their endfoots towards parenchymal
and supportive measures to increase the quality blood vessels. That will be followed by a blood
of working conditions in such environments, im- flow in consonance with the level of neuronal ac-
proving working lives of nurses, and thus prevent- tivity. Astrocytes are in a bipartite relationship
ing the deterioration of the quality of care. with neurons (they modulate neuronal activity by
the way of gliotransmitters), but signals staring
from parenchymal blood vessels can also modu-
late their activity.
Conclusions: Functional integration of the
components of neurovascular unit, through an ef-
ficient, but sometimes redundant signaling sys-
tem, is essential in providing extremely high ener-
getic requirements, with the avoidance of
hypoperfusion (ischemia, infraction) or hyperper-
fusion (edema) that would generate undesirable
disorganizing functional consequences.

ABSTRACTS
(218) Cerebrovascular (219) The effect of curcumin

myogenic tone in A-431 epidermoid
Angela Madalina Lazar1, Leon Zagrean2 carcinoma cell line
1
University of Medicine and Pharmacy Carol Oana-Alina Ciolac, Alexandru Filippi,
Davila, Bucharest, Romania Teodora Costea, Constanta Ganea,
2
Discipline of Physiology and Fundamental Maria-Magdalena Mocanu
Neuroscience, University of Medicine and
Pharmacy Carol Davila, Bucharest, Romania Department of Biophysics, University of Medicine
and Pharmacy Carol Davila, Bucharest, Romania
Objectives: Cerebrovascular autoregulation
provides proportionality between the level of Objectives: A-431 is a hypertriploid human
neuronal activity and the supply of oxygen and epidermoid carcinoma cell line used in experi-
glucose requirements by cerebral blood flow. As mental medicine. A natural compound, curcumin
brain energetic reserve is reduced, oxidative me- might represent a potential alternative to classical
tabolism is extremely high and this complex struc- therapy as a modality to inhibit the proliferation
ture is located in an inextensible cavity, with deli- of cancer cells. The main objectives of our study
cate parenchymal capillary endothelium of included: to evaluate the effect of curcumin on
blood-brain barrier, an adequate regulation of cell proliferation and cell viability.
focal blood flow is essential. A fundamental com- Methods: A-431 cell line was grown in DMEM
ponent of cerebrovascular auto-regulation is the supplemented with 10% FBS, 1% L-Glutamine,
mechanic control, as an intrinsic feature of vascu- 100 IU/ml Penicillin and 100 g/ml Streptomycin
lar tone, determined by blood transmural pres- in a humidified atmosphere at 37C with 5%
sure that creates a relative independence of blood CO2. The cells were passaged twice per week.
flow from blood pressure variations. The aim of Cell cycle was evaluated after PI/RNase staining
the current work is to analyze the mechanisms by flow cytometry using Gallios flow cytometer.
that are at the base of myogenic tone, with their Contrast phase microscopy and fluorescence mi-
integration from an improved, updated perspec- croscopy were used to analyze the cell density
tive. after curcumin treatments. Cell viability and the
Methods: Recent research data have been ability to form colonies after curcumin treatment
represented and modelled with the help of sev- have been investigated by flow cytometry: dye
eral modern software used for graphical repre- exclusion method (7-AAD staining) and, respec-
sentation and interaction for biological networks tively, clonogenic assay. Mitochondrial membrane
in order to identify new targets for better thera- potential (JC-1 staining) was evaluated by flow
pies. cytometry. The following concentrations of cur-
Results: The initiation of vascular myogenic cumin were applied: 5, 10, 25, 50 and 100 M
tone is achieved through mechano-transducers for different periods of time from 48 till 72 h.
from vascular smooth muscle cells. Receptors that Results: The highly proliferative A-431 cells
are coupled to Gq/11 proteins, such as AT1R, have been blocked in G2/M phase after the treat-
P2Y4 and P2Y6, CysLT1R without ligand have ment with curcumin for 72 h, in correlation with
been proved to be mechanic-sensors of local ar- reduction in G0/G1 phase. Cell viability evaluat-
terial pressure variations. Ionic channels of TRP ed by dye exclusion method and flow cytometry
family, regarded as primary mechano-sensors un- indicated that A-431 cells are sensitive to cur-
til now, will trigger the activation of L- and T-type cumin at concentrations starting with 25 M. Fur-
voltage dependent channels through a depolar- ther data supported the previous results: concen-
izing influx. Ca2+ influx will initiate contraction by trations of curcumin higher or equal to 25 M
activating MLCK. inhibited colony formation, induced collapse of
Conclusions: Myogenic tone ensures stability the mitochondrial membrane potential, and re-
in cerebral blood flow despite variations in blood duced cell density.
pressure, being based on a contraction degree on Conclusions: Our results confirm the anti-
which several other autoregulation factors inter- cancer activity of curcumin suggesting both che-
vene with either vasoconstrictive or vasodilator mopreventive and therapeutic outcomes.
effects. Disturbance in the myogenic tone of ce-
rebral small blood vessels becomes of devastating
functional consequences.

ABSTRACTS
(220) EGCG reduces tions. Since the mitochondrial depolarization can

be associated with both necrosis and apoptosis,
partially the expression we evaluated the nuclear staining which showed
level of intracellular chromatin condensation and nuclear disassembly
in both cell lines suggesting apoptosis as the prob-
phosphorylated proteins in able mechanism of cell death.
correlation with induction Conclusions: Our data suggests that EGCG
of cell death in epidermoid administration might reduce the unfavorable
traits associated with ErbB proteins overexpres-
and mammary cancer cell sion, partially inhibiting activated key mediators
lines of the ErbB signaling pathways, reducing the col-
ony formation ability and promoting cell death.
Alexandru Filippi1, Tiphanie Picot2,
Carmen Mariana Aanei1, Lydia Campos1, (229) The role of the family
Constanta Ganea1, Maria-Magdalena
Mocanu1
doctor in increasing the
1
compliance to the
Davila, Bucharest, Romania immunization program
2
University Hospital of Saint-Etienne, France
Gabriela-Loredana Popa1, Madalina
Objectives: We aim to investigate the effect Preda1, Silvana-Adelina Gheorghe1,
of epigallocatechin-3-O-gallate (EGCG), the main Mihaela-Roxana Huhu1, Octavian Costin
catechin in green tea, in two cancer cell lines with Ioghen1, Andreia Florina Nita2, Mircea-
ErbB proteins overexpression: A-431, epidermoid Ioan Popa1
carcinoma cell line and SK-BR-3, breast cancer
1
cell line. In order to accomplish our aim we pro- University of Medicine and Pharmacy Carol
posed the following main objectives: to study the Davila, Bucharest, Romania
2
ability of EGCG to inhibit intracellular signaling Colentina Clinical Hospital, Bucharest, Romania
proteins hyperphosphorylated in cancer cell lines
and to examine the capacity of EGCG to induce Objective: A decrease of the immunization
cell death using different techniques. coverage rates has been reported in the last years.
Methods: A-431 and SK-BR-3 cell lines were The background of this phenomenon is very
grown according to their specification. To evalu- complex, but probably it is mainly caused by the
ate the changes in the expression level of intracel- fear of adverse effects, the lack of knowledge re-
lular proteins (pAkt, pERK, pFAK) after 48 h of garding the benefits of vaccination and the lack of
EGCG administration, flow cytometry technique efficient awareness campaigns from the public
was used. The changes in cell viability/ cell death health authorities.
after EGCG treatment was investigated by flow Our objective was to describe the factors that
cytometry after staining the cells for reactive oxy- underlie the anti-vaccination movement in Ro-
gen species (carboxy-H2DCFDA staining), mito- mania, as well as to create a valid baseline for
chondrial membrane potential (JC-1 staining) and further improved strategies to solve this problem.
by clonogenic assay. Fluorescence microscopy Methods: We designed a cross-sectional sur-
was used to evaluate the nuclear morphology vey and applied the questionnaire to 475 people.
changes (Hoechst staining). Its aim was to verify participants knowledge on
Results: Flow cytometry data demonstrated the benefits of immunization, whether or not
that 48 h treatment with 50 M EGCG induced they vaccinated their children, and the sources of
partial inhibition of pAkt (S473), pERK (Y204) and the information they possessed. Moreover, we
pFAK (S910) in both cell lines. We further studied evaluated peoples perceptions of the attitude
the clonogenic potential of EGCG treated A-431 their family doctor has towards vaccination. Data
and SK-BR-3 cells for 48 h, which demonstrated have been processed using Epi Info (version
growth inhibition in both cell lines at lower con- 7.1.5.2).
centrations. EGCG treatment for 72 h showed Results: Out of the 475 participants, 409
dose dependent increase in ROS and subsequent were parents and 92.42% (95%CI: 89.30%-
cell death. These observations were correlated 94.71%) of them had vaccinated the children ac-
with the mitochondrial membrane depolarization cording to the national immunization schedule.
induced by EGCG in the same treatment condi- The great majority of the participants (95.15%;

ABSTRACTS
95%CI: 92.70%-96.83%) affirmed that they were caused by O157:H7, which is the VTEC proto-
aware of the benefits of vaccination from various type. Earlier this year, a VTEC O26 outbreak oc-
sources, like the internet, television, healthcare curred among Romanian children, most of them
workers, family and friends. Most of them from a Southern district. Our objectives were to
(82.83%; 95%CI: 78.89%-86.10%) had received define the molecular basis of virulence, the phy-
information from their family doctor. However, logenetic background, and the genetic related-
45.47% (95%CI: 40.95%-50.08%) of the respon- ness of the autochthonous VTEC O26 isolates.
dents believe that vaccines imply risks which out- Method: The investigated samples included
grow the benefits. A high percentage of the par- in the study originated from children with hemo-
ticipants to the study, 80.72% (95%CI: lytic uremic syndrome (HUS) and/or with a his-
76.81%-84.12%), have been informed by their tory of (bloody) diarrhea. E. coli VTEC O26 strains
family doctor that immunization is absolutely were detected and characterized using pheno-
mandatory, especially for the children. typic (biotyping and serotyping) and genetic (PCR
Conclusions: In order to maintain the ad- screening of virulence genes) methods. Phyloge-
vances medicine has accomplished in fighting ny was assessed by using Multilocus Sequence
vaccine-preventable diseases, it is highly impor- Typing (MLST) and genetic relatedness by using
tant to raise the awareness and compliance of the pulsed-field gel electrophoresis (PFGE) of XbaI
population to the immunization programs. Gen- macrorestriction DNA fragments.
eral practitioners should reinforce the knowledge Results: The PCR assays showed that the au-
of their patients regarding vaccination benefits tochthonous E. coli O26 strains carried at least
and attend their fears about potential risks. Even one of the genes responsible for the production
though vaccination is still a personal decision in of VT1 (vtx1) and VT2 (vtx2), the toxins described
Romania, people should be helped by the family to have a prominent role in the pathogenesis of
doctors to understand that it is also a collective VTEC bacteria. The vtx subtyping protocol indi-
responsibility. cated that all vtx1 genes corresponded to the
vtx1a subtype and all vtx2 corresponded to the
(235) Molecular vtx2a subtype. The strains harbored additionally
the genes encoding for the adhesin intimin (eae)
characteristics of and enterohemolysin (ehxA). MLST analysis re-
verocytotoxin-producing vealed that all the VTEC O26 strains belonged to
ST21 lineage. Multiple PFGE patterns were found
Escherichia coli O26 among the tested strains.
isolates originating from Conclusions: The results confirm the circula-
Romanian children tion across our country of E. coli serogroup O26
members that qualify as VTEC. An enhanced na-
Codruta-Romanita Usein1, tional surveillance of such pathogens is needed
Adriana Simona Ciontea1, Madalina considering their potential to cause life threaten-
ing human disease. The knowledge of the viru-
Cornelia Militaru1, Maria Condei1,
lence profiles and genetic background of the
Mihaela Oprea1, Lavinia Cipriana Zota2, clinical isolates is mandatory for a better under-
Alina Zaharia3 standing of the epidemiology of autochthonous
1
National Institute of Research Cantacuzino, infections.
Bucharest, Romania
2
National Centre for Surveillance and Control of
Communicable Disease, Bucharest, Romania
3
National Institute of Public Health, Bucharest,
Romania
Objective: Verocytotoxin-producing Esche-

richia coli (VTEC) is a food-borne pathogen that
may cause severe human infections such as hem-
orrhagic colitis and hemolytic uremic syndrome
(HUS). Worldwide, VTEC serogroup O157 strains
are responsible for most human infections. How-
ever, VTEC serogroup O26 has emerged as a
common cause of disease that is as severe as that

ABSTRACTS
(246) Oxidative stress 0.01 in PLGA group vs control group AOPR

levels detected in spleen: 1.440.47 vs
assessment after PLGA 2.060.46 and liver: 1.880.1vs 1.880.1, for
nanoparticles PLGA vs control group respectively.
Conclusion: Present data shows that acute
administration in Wistar oral administration of a high concentration of
rats PLGA NPs induces a change in the antioxidant
status in both rat liver and spleen but may not
Daniela Miricescu1, Bogdan Calenic2, induce oxidative stress damage to cell structures
Alexandra Totan3, Daniela Badita3, such as lipid or protein oxidation.
Iulia-Ioana Stanescu1, Radu Radulescu2, Acknowledgment: D.M. would like to thank
Bogdana Virgolici3, Cristina Sabliov3, for the Young Scientist Grant 2014-2016 received
from University of Medicine and Pharmacy Carol
Bogdan Ianca1, Maria Greabu2 Davila, Bucharest, Romania.
1
Department of Biochemistry, University of
Medicine and Pharmacy Carol Davila, Bucharest, (262) Nomophobia. Half of
Romania
2
Faculty of Dental Medicine, University of us suffer from it. Do you?
Andrei Gresita, Ana Maria Petrescu,
Romania
3
University of Medicine and Pharmacy Carol Alexandra Daniela Zavaleanu, Carmen
Davila, Bucharest, Romania Statescu
University of Medicine and Pharmacy, Craiova,
Objectives: In the recent years, engineered Romania
nanoparticles such as PLGA or poly-lactic-co-gly-
colic acid, have raised a substantial interest due Objectives: Nowadays technology has greatly
to their possible medical applications in vaccina- changed the way humans perform their daily
tion, diagnostic imaging procedures, cancer ther- tasks. But among the great advantages of using
apy or sustained delivery of drugs.The main aim technology, new pathologies either physical or
of the present work is to evaluate key oxidative psychiatric are starting to emerge. Nomophobia is
stress parameters in several organs following NPs one of them. It can be described as the fear of
administration in an animal model. being out of mobile phone contact. People who
Methods: Polymeric nanoparticles of PLGA suffer from this phobia start being anxious when
were prepared by emulsion-solvent evaporation they are either away from their mobile device or
method and were a kind gift from Prof. Sabliov, lose it. It can also be triggered by situations like
Lousiana State University, USA. The animal mod- running out of battery, or losing network cover-
el involved rats divided in 2 groups as follows: 5 age.
rats were used as control group and 5 rats were Methods: The study was carded out on a
administered NPs at a concentration of 50mg/kg group of 210 individuals, with ages between 15
body weight. The NPs were given orally using a and 60 years old. Each person had to complete a
feeding canula; rats were sacrificed at 6 hours survey containing a series of simple questions. In
and tissue samples from spleen and liver were addition to this, a number of smaller groups were
analyzed for oxidative stress indicators such as selected and divided by age and gender. The
glutathione (GSH), malondialdehyde (MDA), to- groups were also separated into test and control
tal antioxidant capacity (TAC) and advanced hu- in order for us to compare the different results.
man oxidation protein products (AOPP). Results: Based on the data we gathered, we
Results: A significant difference was found in managed to notice that more than 62% of the
GSH and TAC levels between the two groups in people we enquired suffer from nomophobia. By
both analyzed organs: spleen 0.60 0.18 vs. further analyzing their feedback we concluded
0.93 0.02 and liver 0.84 0.04 vs. 0.93 that anxiety, stress, and even concentration issues
0.04 in PLGA group vs control group. For TAC the were present among individuals with nomopho-
results showed: in spleen 92.63.46 vs bia. What is more, 32% of all the individuals in
93.43.46, in liver 1149.58 vs 101.93 in the the test group manifested an increase in their
PLGA group vs control group. MDA levels be- heart rate, high blood pressure, shortness of
tween the two groups were reported as follows: breath and even panic attacks while being away
spleen 0.01 0.01 vs 0.09 0.01 in PLGA from their mobile device. We also discovered that
group vs control group; liver 0.04 0.01 vs. 0.02 women are more affected than men.

ABSTRACTS
Conclusions: Nomophobia affects a great er stroma. On high-power examination, the en-

number of individuals which is continuously ris- dometrial epithelium is one cell layer thick. The
ing especially among young people who tend to cells are tall and columnar with elongate cigar-
heavily rely on modern communication means. shaped nuclei showing regular vertical orienta-
Although it may seem harmless, nomophobia can tion. The cytoplasm is with multiple cytoplasmic
cause serious pathologies such as panic attacks, vacuoles and stroma generally resembles the nor-
severe stress, shortness of breath, accelerated mal stroma found in the endometrium, and con-
heart rate, dizziness, chest pain and nausea. Most sists of small round to spindle-shaped cells with
of the people who suffer from this phobia can rely inconspicuous cytoplasm. Immunostaining for
on self-help methods as treatment. Our belief is CD10 can facilitate the recognition of the stromal
that a phobia that can be easily ignored such as cells, particularly when sparse and when glandu-
nomophobia can rapidly expand into a serious lar epithelium is minimal or absent.
global health risk if left unstudied. Conclusions: The overall frequency of post-
Cesarean scar endometriosis is increased with the
(264) Endometriosis related risk of incisional endometriomas that may result
from failure to close the parietal and visceral peri-
with pregnancy toneum with sutures. Internal endometriosis is
the most obvious reason for infertility caused by
Ioana Dumitru, Adrian Vasile Dumitru
direct involvement of adnexal organs or by its
University of Medicine and Pharmacy Carol secondary effects.
Objective: Endometriosis is a common com-

(268) Data regarding the
plication after pregnancy. The perineum, and distribution of seasonal
perianal region are areas of obstetric trauma, 2015-2016 influenza
most commonly episiotomy scars and can devel-
op external endometriosis. vaccines among family
Method: In a 3 year retrospective study on doctors from the South of
282 cases with endometriosis we identified 39
cases of pregnancy related external endometrio-
Romania
sis (abdominal wall, pelvis, peritoneum, omen- Gabriela-Loredana Popa1,
tum) and 16 cases of pregnancy related internal Silvana-Adelina Gheorghe1,
endometriosis (ovarian and fallopian tube).
Results: The clinical signs were localized pain
Madalina Preda, Mihnea Gabriel Popa2,
with redness, edema and a brown-blue patch or Mircea-Ioan Popa3
nodule and pelvic pain synchronized with the 1
menstrual cycle. During pregnancy visible endo- Davila, Bucharest, Romania
metriotic lesions frequently undergo initial en- 2
ASSET (612236)
largement, with occasional ulceration and bleed- 3
FP7-SCIENCE-IN-SOCIETY-2013-1
ing, followed by shrinkage and stromal decidua-
lization. Within the endometriotic lesion the en- Background: Primary care settings, where in-
dometrial epithelium can suffer Arias-Stella reac- fluenza vaccination is usually promoted and im-
tion. With time the endometriotic deposits plemented in Romania, are a key aspect in achi-
change their gross appearance. On gross findings eving satisfactory immunization coverage. Influ-
most often we identified brown to yellow-brown enza surveillance data from the European Centre
lesions that indicates the presence of hemor- for Disease Prevention and Control shows that
rhage, powder burns on the omentum and old previous seasons were severely affected, with
lesions (white) with fibrosis and scarring that can high rates of complications and mortality. Our
determine infertility. From the microscopic point study aimed to explore family doctors` attitudes
of view the endometriotic lesions fulfilled the tri- towards the seasonal influenza vaccination this
ad: endometrial glands, endometrial stroma and year, and also their cooperation with the public
the presence of hemorrhage and hemosiderin. At health authorities for providing patients with the
the abdominal wall we identified endometrio- best preventive strategies.
mas-blood filled space lined by a flat epithelium Methods: We developed a questionnaire for
and underlying stroma. On low-power magnifica- a cross-sectional survey study, and sent it to fam-
tion, the endometrial epithelium is thin, dark ily doctors from the South of Romania (Bucharest
layer sharply delineated from the underlying pal- and other 17 counties), starting from November

ABSTRACTS
2015, until March 2016. Data analysis was per- and the second trimester of pregnancy (Z=
formed using Epi Info (version 7). -4.528, p<0.0001). The mean values decreased
Results: Following a preliminary analysis of during pregnancy from 80.6 ml to 65.7 ml. We
the data, the response rate was about 80%, as obtained strong correlation with cardiac output,
some colleagues sustained that the information heart rate and sistemic vascular resistance.
we were asking for is confidential. Almost two Conclusion: Impedance cardiography offered
thirds of the participants received the first vac- the hemodynamic profile of all trimesters of preg-
cines later than the recommended immunization nancy in healthy woman. Impedance cardiogra-
time (October), therefore some patients refused phy can evaluate stroke volume during pregnancy
to use them. The second vaccines were shipped in a feasible and noninvasive way.
by the public health authorities also extremely
late, in January and February, in many cases. Only
14% of the family doctors have ordered supple- (277) Appendiceal mucocele:
mentary immunization doses. what lies beneath a clinical
Conclusions: Influenza vaccines shipment diagnosis?
should be better performed, according to the op-
timal immunization time. For this reason, we Gabriel Pop1, Sabina Andrada Zurac1,
should count again on the national supplier for Florica Staniceanu1, Eliza Gramada1,
vaccines, Cantacuzino Institute. In Romania,
Luciana Nichita1,
there is a need for improving the immunization
awareness, from the healthcare providers per- Alexandra Ioana Dragusin1,
spective, but also from the patients one. More- Alexandru Croitoru2,
over, the public health authorities should endeav- Cristiana Gabriela Popp1
our to work together with family doctors and 1
Pathology Service, Colentina Clinical Hospital;
ensure the proper procurement and distribution
Faculty of Dentistry, University of Medicine and
of vaccines.
2
Department of General Surgery, Colentina
(269) Stroke volume Clinical Hospital, Bucharest, Romania
changes during pregnancy
Objectives: Appendiceal mucocele is a rare
in healthy woman finding, occurring more frequently in women and
Romina-Marina Sima1, Ioana-Anca elderly people. This term comprises both benign
and malignant appendiceal mucinous neoplasms,
Badarau1, Catalina Ciornei2, but it also associates frequently colon and ovarian
Raluca Papacocea3, cancer. The most feared complication of this dis-
Anca-Daniela Stanescu1, Liana Ples1 ease is perforation with subsequent development
1
University of Medicine and Pharmacy Carol of pseudomyxoma peritonei. Appendiceal tu-
Davila, Bucharest, Romania mors invading beyond the muscularis mucosae
2
Bucur Maternity, Bucharest, Romania are categorized as adenocarcinomas. If the tumor
3
Hospital Sf. Ioan, Bucharest, Romania associates pseudomyxoma peritonei and ovarian
involvement, the differential diagnosis from an
Objectives: Impedance cardiography is a ovarian primary is made considering the greater
noninvasive method that evaluates the hemody- amount of gelatinous ascites with very few tumor
namic profile. It has a long history but there are cells, larger peritoneal nodules and cells positivity
new studies that prove its applicability in new for PAS-Alcian and MUC2 suggestive of the ap-
medical fields including obstetrics. pendiceal origin.
Methods: We performed a prospective study Methods: We present six cases of appendi-
that included healthy women in all trimesters of ceal mucocele: five appendiceal mucinous ade-
pregnancy. We evaluated their hemodynamic nocarcinoma and one appendiceal mucinous ad-
profile using impedance cardiography. enoma. All tumors manifested clinically as acute
Results: Our study included a number of 141 appendicitis. Histological examination and im-
healthy pregnant women. We evaluated the munohistochemical tests revealed five cases of
stroke volume in each trimester of pregnancy. We appendiceal mucinous adenocarcinoma, one
observed that stroke volume decreased in the last limited to the subserosa, three with pseudomyxo-
trimester of pregnancy compared with the first ma peritonei, and one with synchronous serous
trimester of pregnancy (Z= -4.852, p<0.0001) cystadenocarcinoma of the ovary. The other case

ABSTRACTS
was an appendiceal mucinous adenoma with Panton-Valentine Leukocidin (PVL/ lukS/F), exfo-
synchronous serous cystadenocarcinoma of the liative toxins (ETA, ETB/ eta, etb), toxic shock syn-
ovary with mesoappendiceal metastasis. drome toxin (TSST/ tst), protein A (spa); spa-typ-
Results: Of the five cases of appendiceal mu- ing by sequencing.
cinous adenocarcinoma one is poorly differenti- Results: SSTI strains spa-types distribution:
ated, with peritoneal spread with pseudomyxoma t127 (13), t044 (5), t008 (3), t284 (3), t019 (2),
peritonei; the remaining four are well differenti- t2881(2) and other 14 spa-types with 1 strain
ated, with peritoneal spread and pseudomyxoma each; 20 strains positive for lukS/F genes, 2 posi-
peritonei in two cases, serosal invasion in one tive for tst; 59.52% MRSA. HAI strains spa-types
case while one only invades the subserosa; there distribution: t127 (24), t008 (11), t015 (3), t002
is also an appendiceal mucinous adenoma with (3), other 9 spa-types with 1 strain each; 13 strains
synchronous serous cystadenocarcinoma of the positive for lukS/F genes, most of which of spa
ovary. t008 type; 58% MRSA.
Conclusions: Appendiceal mucinous tumors Conclusions: Spa type t127 S. aureus strains
are usually an incidental finding during surgical predominated, both in CA-SSTI and in pediatric
procedures for a presumed acute appendicitis. hospitals, followed by spa type t008, most of
Correct diagnosis, based on specific macroscopic which were PVL positive. As the predominant
aspects and, sometimes, intraoperative extempo- clones have been initially recognized as Commu-
raneous examination are the keys for a proper nity-Associated, our results proved the introduc-
treatment (hemicolectomy). tion from community to hospital of these clones
that are currently successfully evolving in pediat-
(301) Staphylococcus aureus ric hospitals. These findings support the need to
improve infection prevention interventions and
clones in community and to strengthen surveillance and control programs.
hospital settings, 2013-2014
Irina Codita1, Elena-Carmina (309) Primary dural high
Dragulescu2, Brindusa-Elena Lixandru1, grade follicular lymphoma:
Roxana Serban3 a rare malignancy
1
National Institute of Research Cantacuzino, Diana Maria Bran1, George Simion1,
Bucharest, Romania A. Cristescu1, Maria Sajin1,
2
Mariana Costache1, Ion Aurel Iliescu1,
3
Faculty of Biology, Bucharest University, Tiberiu Augustin Georgescu1,
Romania Adrian Dumitru1, Mihai Palaga2
1
Department of Pathology, University of Medicine
Objectives: Staphylococcus (S.) aureus is rec- and Pharmacy Carol Davila, Bucharest, Romania
ognized as a frequent cause of Healthcare Associ- 2
Department of Neurosurgery, Emergency
ated Infections (HAI). In community it is mainly University Hospital, Bucharest, Romania
involved in Skin and Soft Tissues Infections (SS-
TIs), most of which recurrent. Therefore, SSTIs Objectives: Primary central nervous system
are considered a reservoir of S. aureus strains. lymphomas are extra-nodal non-Hodgkin lym-
Our study objectives consisted of comparing mo- phomas that arise from brain parenchyma, eyes,
lecular, virulence and antimicrobial resistance meninges, or spinal cord in the absence of sys-
profiles of strains isolated from community recur- temic disease. Primary dural lymphoma is a rare
rent SSTI with those of strains isolated from HAI subtype of primary central nervous system lym-
outbreaks. phoma that arises from the dura mater and bio-
Methods: 42 S. aureus strains isolated in Can- logically differs from other central nervous system
tacuzino Institute Laboratory from patients with lymphomas.
recurrent SSTI in January November 2014 and Methods: We report a case of a 63 year old
50 strains isolated from outbreaks in two pediat- immunocompetent female patient diagnosed
ric hospitals, during 2013-2014 interval. Strains with a high-grade follicular lymphoma presenting
identification: classical bacteriological tests and as a primary lesion of the intracranial dura. Based
PCR for: nuc gene, according to a protocol option the preoperative MRI, our patient was pre-
mized in our laboratory (Dragulescu and colab., sumed to have a meningioma, as the extra-axial
2007). Detection by PCR of genes coding for:

ABSTRACTS
lesions appeared isointense on T1-weighted MR tective effect of oxytocin after incremental OGD
images and diffusely enhanced after gadolinium exposure periods of 1, 1.5 and 2 hours. We also
administration. Meningiomas are far more com- tested the effect of the GABA-A receptor antago-
mon than high-grade follicular lymphomas and nist gabazine on neuronal viability in OGD condi-
according to the MRI our patient had a very sig- tions.
nificant chance to have one. Results: Oxytocin was shown to decrease cel-
Results: The patient was surgically treated lular viability measured by resazurine only in
and the excised specimen was sent to a histopa- OGD conditions (47.85% 3.90%, n=16,
thology exam. After special immunohistochemis- ***p0.0001). Gabazine was shown to increase
try techniques, the patient was diagnosed with cellular viability/metabolism (81.44% 7.30%,
primary dural high grade follicular lymphoma. n=8, ***p0.0001), which was not decreased
The patient followed radiation therapy, initially significantly by adding oxytocin (82.48%
achieving a complete response with good local 4.062%, n=13, ***p0.0001).
disease control. Unfortunately, her condition sub- Conclusions: Oxytocin may be detrimental to
sequently worsened and eventually the patient mature neurons under ischaemic conditions,
passed away. whereas inhibition of GABA-A channels by gaba-
Conclusion: Our clinical case is so extraordi- zine may be neuroprotective. Further studies are
nary because primary dural high grade follicular needed to research intracellular chloride dynam-
lymphoma is indeed a very rare malignancy. ics under pathological conditions.
Moreover, we can present the MR images which
strongly suggest a meningioma and the histopa- (320) Anatomical study and
thology slides which eventually put the definite
diagnosis of primary dural high grade follicular clinical milestones posterior
lymphoma. cranial fossa
Miruna Parlog,
(310) Mature hippocampal
Diana Georgiana Dumitru
cultures response to
oxytocin treatment during Davila, Bucharest, Romania
oxygen-glucose deprivation
This topic was chosen because of the com-
and reoxygenation plexity of anatomical posterior cranial fossa re-
Mara Ioana Iesanu, Diana Chitimus, gion and numerous relationships between cranial
Ioana Florentina Grigoras, nerve and vascular structures at this level .
This paper is a study focused specifically on
Ana Maria Zagrean posterior cranial fossa anatomical approach due
Discipline of Physiology and Fundamental to the fact it brings data to support the develop-
Neuroscience, University of Medicine and ment of therapeutic procedures related to pathol-
Pharmacy Carol Davila, Bucharest, Romania ogy at this level.
Posterior cranial fossa contains vital structures
Objectives: Oxytocin was found to modulate of the central nervous system: the brainstem and
GABA-A activity in developing neurones by re- cerebellum and also the pairs of 10 cranial nerves
versibly changing intracellular chloride concen- (3 to 12). At this level there are ways of cerebro-
tration. This was previously shown to have a neu- spinal fluid drainage from the ventricular system
roprotective effect on immature neurones during in the subarachnoid cisterns.
ischaemic conditions in vitro. In the present study Objective: The objective of this paper is to
we explore the effect of oxytocin treatment on describe in detail the anatomy of the posterior
mature neuronal cultures exposed to OGD. cranial fossa and anatomical landmarks at this
Methods: Primary cultures of hippocampal level which have a great importance in surgery.
neurons were obtained from postnatal-day 0 Wi- Methods: Dissections were performed on
star-rat pups. Cultures at 7-8 days in vitro (DIV), posterior cranial fossa highlighting the relation-
were exposed to OGD or control conditions, with ships at this level on three anatomical specimens
or without oxytocin treatment. Assessment of cel- of the Anatomy Department at University of
lular viability was performed using a resazurine Medicine and Pharmacy Carol Davila and MR
assay after 3-hours of reoxygenation in a normo- imaging investigations related to posterior cranial
glycemic medium. We evaluated the neuropro- fossa from 10 subjects. Subsequently, the ob-

ABSTRACTS
tained data were correlated anatomically and nasal reconstruction using the forehead flap. Even
paraclinically. if this flap was first used three centuries ago, the
Results: Following the results, we conclude experience of the surgeon depends on the cor-
posterior inferior cerebellar artery variability and rect mapping the pedicle and the right placement
trigeminal artery are the most common variants of the flap.
with significant clinical implications in the poste-
rior cranial fossa. Also, a clinical implication with (325) Ultrasonographic
major importance is the asymmetry of venous si-
nuses at this level. diagnosis of the umbilical
Conclusion: Posterior cranial fossa anatomy cord abnormalities
has great clinical importance because its pathol-
ogy is extremely diverse: traumatic , vascular, in- Afrodita-Oana Panaitescu, Cristiana
fectious, congenital malformations all these enti- Voicu, Mihaela Pirvu, Roxana-Daniela
ties requiring different surgical approaches accor- Giurgiu, Alexandra Dumitrache, Tudor
ding to location, size and complex relations with
Iacovache, Laura Oana Stroica
nerves and adjacent vascular structures. Failure in
detailing the anatomical relations in some surgical University of Medicine and Pharmacy Carol
procedures may lead to severe complications. Davila, Bucharest, Romania
The incidence of umbilical cord pathology is

(322) Anatomical landmarks high in abnormal course of the delivery. Due to
for the forehead flap the evolution of ultrasonographic technology,
many of these anomalies are being diagnosed in
Mihaela Pirvu, Alexandra Ioana utero.
Dumitrache, Roxana Giurgiu, It is reported that prenatal detection of um-
Cristiana Voicu, Afrodita Oana bilical cord abnormalities shall reduce the num-
Panaitescu, Laura Stroica, Ioana Albu ber of emergent cesarean sections and intrauter-
ine fetal death. In this study we analysed the
University of Medicine and Pharmacy Carol ultrasound diagnosis and management of several
Davila, Bucharest, Romania umbilical cord abnormalities.
Objectives: One of the main aims of routine
Objectives: The forehead flap is used for na- antenatal care is to identify the fetus at risk, in
sal reconstruction. The most common artery of order to apply clinical interventions, which could
this flapss pedicle is the supratrochlear artery, but result in reduced perinatal morbidity and mortal-
the literature describes additional arterial sources ity.
represented by branches of the supraorbital ar- Methods: The Color Doppler ultrasound is
tery and even the angular artery. used to examine the umbilical blood flow, leading
There are several landmarks that can be used to an early diagnosis of important congenital and
for identifying the course of the supratrochear ar- functional anomalies. This examination can as-
tery such as the glabellar frown line or the medial sess the cord thickness and coiling, the number of
canthus. The width of the pedicle must take into vessels and their blood flow.
account these landmarks for a good result both Results: For the persistent right umbilical
functional and aesthetic. vein, the diagnostic criteria are: portal vein curved
Methods: For this study we dissected 5 for- towards the liver, fetal gall bladder located medi-
maline fixed faces in the Anatomy Department of ally to the umbilical vein ,which is abnormally
Carol Davila University of Medicine and Phar- connected to the right portal vein instead of the
macy. We identified the supraorbital and supra- left.
trochlear arteries, measured the diameters and Vasa previa is a rare condition which occurs
the distances form the arteries to the several ana- when the fetal vessels in the membrane are situ-
tomical landmarks. ated in front of the presenting part of the fetus
and its cause is unknown.
Results: The mean diameter of the supratro-
Single umbilical artery is believed to be caused
chear artery was 0,92 mm, and the mean dis-
by atrophy of a previously normal artery, pres-
tance from the supraorbital rim to the emergence
ence of the original artery of the body stalk, or
of the supraorbital arteries varies between 11 and
agenesis of one of the umbilical arteries.The diag-
27 mm.
nostic criteria is finding only two vessels on a cross
Conclusions: The throughout knowledge of
section of the cord, or a vessel seen on only one
the forehead anatomy is the key for a successfull side of the fetal bladder.

ABSTRACTS
Conclusions: The integrity of the umbilical strains. Yet, monoresistance does occur and can
cord plays an essential role in fetal development potentially lead to incorrect classification and
and must be very carefully assessed at ultrasound treatment in some strains in which first line drugs
examination. Some of the cord abnormalities are may still be useful. While there was disagreement
associated with other fetal malformations. After between the 3 methods of susceptibility testing,
detecting an umbilical cord abnormality, further both molecular methods had high sensitivity and
imaging and genetic studies are needed in order specificity and were in high agreement with the
to manage this condition and the associated pa- phenotypic assays. GenoType MDRTBplus has
thology, a combination which can lead to intra- the advantage of providing results for both RIF
uterine growth restriction and fetal demise. and INH resistance.
(326) Genetic diversity of (329) Hox genes and their

Mycobacterium tuberculosis importance in the
rpo-mediated resistance in development of limbs
a tertiary pneumology Andreea Ionovici, Nayyerani Reza,
hospital in Bucharest Angela Ilie
Adriana Moisoiu1, Andrei-Alexandru University of Medicine and Pharmacy Carol
Muntean2, Mircea Ioan Popa2 Davila, Bucharest, Romania
1
National Institute for Pneumology Marius Nasta, Objective: Nowadays, thousands of children
Bucharest, Romania all over the world are born with limbs malforma-
2
University of Medicine and Pharmacy Carol tions. Given the role that genes have in the evolu-
Davila, Bucharest, Romania tion of the fetus, the aim of this study is to empha-
size the importance of Hox genes in limbs
Objectives: To characterize the genetic diver- development during fetal life.
sity of rpoB mutations and performance charac- One study has shown that in vertebrates Hox
teristics of 3 antibiotic susceptibility assays for the genes are located in four clusters on different ch-
diagnosis of RIF and INH resistance. romosomes: HoxA-7p15,HoxB-17q21.2, HoxC-
Methods: A retrospective study was carried 12q13, and HoxD-2q31. During the embryonic
out on all mycobacteria strains of isolated from development, Hox genes are expressed in the
inpatients hospitalized in the Marius Nasta Pneu- gastrulation period when the evolution of the
mology Institute, in the first half of 2011. Drug cranio-caudal axis takes place. These genes de-
sensitivity testing was carried is increasing out fine patterns in limbs evolution in vertebrates.
through molecular methods (INNO-LiPA Rif.TB Poor genetic expressions or Hox-DNA mutations
and Geno Type MDRTBplus) as well as pheno- can lead to malformations such as Synpolydacty-
typic methods (antibiotic-containing Lowenstein- ly, Brachydactyly, Hypodactyly or hand-foot-gen-
Jensen). ital syndrome.
Results: A total of 50 distinct strains were iso- Methods: In order to study Hox genes it is
lated from positive cultures. One of the strains necessary to obtain samples from fetal genome
tested negative for Mycobacterium tuberculosis via amniocentesis. Thus the karyotype and ge-
complex and was excluded from the analysis. The netic cartography of the fetal genome can be ob-
INNO-LiPA Rif.TB revealed 28 rifampicine-in- tained.
ducing mutations in the rpoB gene. The Geno- DNA, RNA and proteins profiling must be per-
TypeMTBDRplus system detected a RIF and INH formed. For DNA study there are several methods
resistant inducing mutation in 26, and 25 strains that can be used: DNA sequencing, PCR, in situ
respectively. One mismatch between susceptibil- hybridization or Southern-blot method. For RNA
ity profiles was resolved through the use of phe- study: Northern-blot, RT-PCR, in situ hybridiza-
notypic testing. One low level resistance to INH tion and for protein analysis: Western-blot meth-
was evident only through genetic means, as it od, histochemical analysis.
lacked phenotypic expression. An extensive cata- Results: Studies have shown that Hox genes
logue of resistance mutations is provided. contain two exons and one intron that varies from
Conclusions: Resistance to rifampicin is ac- 200 bases to several kilobases. The second exon
companied, in over 90% of cases by resistance to has a 180 nucleotide sequence called homeobox
isoniazid, serving as a useful surrogate for MDR which encodes 60 amino acids that form the ho-

ABSTRACTS
meodomain, a common DNA-binding structural lin resistant pneumococcus Haemophilus influen-

motif. Genes expression is oriented in the cranio- zae was isolated in a wider range of isolates,
caudal direction so that the 3 genes that specify spanning from 150 to over 350 isolates per year.
the cranially located structures are expressed ear- Haemophillus influezae is less likely to the isolat-
lier than the 5 genes which specify caudal struc- ed from patients in the ICU but is still a formida-
tures. The expression of these genes is modulated ble pathogen. The resistant ESKAPE pathogens
by retinoic acid, 3 genes being more responsive were more likely to be isolated from patients with
to this active substance. underlying comorbidities hospitalized in the ICU.
Conclusion: The research presented in this A detailed analysis of the antibiotic susceptibility
study is of great importance in monitoring the fe- of these isolates follows.
tus development considering that even the small- Conclusions: There seems to be an increase
est flaws in Hox-DNA linkage can produce severe in the number of isolates with increased resis-
limbs malformations. tance. The Marius Nasta Institute handles both
acute infections (pneumonias), exacerbations of
chronic diseases (such as COPD), as well as
(330) Antibiotic chronic colonization by respiratory pathogens.
susceptibility profiles of To our knowledge, this is the first report which
spans such a significant amount of time from in-
potential respiratory patients of a specialized tertiary center from Ro-
pathogens in samples taken mania.
from inpatients of the
Marius Nasta Institute in (334) Listeria
Romania 2010-2013 monocytogenes infection
Andrei-Alexandru Muntean1, Adriana
associated with hip
Moisoiu, Madalina-Maria Florea1, prosthetic implant
Mihaela Roxana Huhu2, Octavian Costin Violeta Corina Cristea1, Roxana Prico2,
Ioghen1, Adelina Silvana Gheorghe1, Radu Serea2, Florina Ojoga2,
Andreea Georgiana Tanase1, Anca Mihai Nicolescu1, Mircea Ioan Popa1
Marilena Dumitrache1, Madalina Preda1, 1
Dragos Cosmin Zaharia1, Miron Davila, Bucharest, Romania
Alexandru Bogdan1, Mircea-Ioan Popa1 2
Synevo, Bucharest, Romania
1
Objectives: Listeria monocytogenes is an im-
2 portant pathogen in pregnant patients, neonates
National Institute for Pneumology Marius Nasta,
and immunosupressed patients. It is also a com-
Bucharest, Romania
mon veterinary pathogen, being associated with
abortion, encephalitis and mastitis in dairy cattle.
Objective: To evaluate the antibiotic suscepti-
The most common cause of this zoonotic infec-
bility profile of respiratory pathogens in infections
from adult inpatients in the biggest tertiary Pneu- tion is represented by contaminated food inges-
mology center in Romania. tion, but also a cutaneous path for this ethiologi-
Methods: We evaluated the diagnostic yield cal agent was documented in healthy individuals
and antibiotic resistance profile of all Streptococ- who had direct contact with infected animals.
cus pneumoniae, Haemophilus influenzae, Mo- This study is focused on Listeria monocytogenes
raxella catarhalis, as well as the ESKAPE group infections associated with the hip prosthetic im-
pathogens (Enterococcus faecalis, Staphylococcus plant.
aureus, Klebsiella pneumoaniae, Acinetobacter Methods: A 61 years old woman, who lives in
baumanii, Pseudomonas aeruginosa, Enterobac- a rural area, returns to the hospital, after being
ter spp) isolates obtained from respiratory sam- subjected to surgery 3 years earlier, presenting
ples in adults hospitalized in the Marius Nasta signs like high fever, shivers and a right hip ab-
National Institute for Pneumonology in Romania scess. Three weeks before, the patient presented
(MNNIP) between the years 2010 and 2013. a cutaneous lesion on the arm, after cattle milk-
Results: We identified over 50 isolates of ing. For this lesion, the patient hadnt been clini-
Stretococcus pneumoniae for each year of study; cally examined, because the wound was non-
there is an increasing trend of diagnosis of Penicil- painful, non-pruritic and self-limited.

ABSTRACTS
Results: After the hospital admission, labora- social support and attachment style were mea-
tory testing results showed inflammatory syn- sured through Social Support Survey Instrument
drome: leukocytosis 13.86 x103/ul (RR 4-10.000/ and Vulnerable Attachment Style Questionnaire
ul), the sedimentation rate was 102 mm/h (RR (VASQ).
3-10 mm/h), and C reactive protein had a peak Results: Higher dominance of anxious attach-
value of 215 mg/L (RR 1-5 mg/L). Blood cultures ment style was met in 45.45% of participants and
were not made. Surgery was performed and the it correlated significantly with the onset of somat-
abcess was punctured and drained, then the pu- ic complaints (p<.05). No direct correlation was
rulent matter was sent to the laboratory. After mi- identified between perceived social support and
crobiological examinations: smears, cultures and somatic complaints. Multiple regression analysis
identification we obtained the ethiological patho- confirmed the single predictive value of the dys-
gen of this infection Listeria monocytogenes. functional anxious attachment style (p<.01).
The antimicrobial susceptibility testing was made Conclusions: These results confirm the im-
in accordance to EUCAST, and showed that am- portant role of a healthy attachment style in pre-
picillin, penicillin, eritromicin and trimethoprim- venting early onset of somatic complaints. This
sulphamethoxazole were sensitive, and merope- supports in turn the idea of physicians and psy-
nem was resistant. The evolution under treatment chologists working together for an early identifi-
was positive, but removal of the hip prosthetic cation of dysfunctional attachment styles and
device was necessary, throught surgical proce- their consequences.
dures for debridement of the necrotic and infect-
ed tissues. (341) Screening for colistin
Conclusions: Although human listeriosis is es-
pecially known as a foodborne disease, this case resistance in Gram negative
shows that infection via direct contact with in- bacilli isolated in one
fected animals (in this case, cattle) is also possible.
Using fast diagnostic procedures, the result for pediatric hospital,
the purulent matter culture was released in only Bucharest, Romania
48 hours, this having a great impact on prediction
and evolution of the infection (disease). Violeta Corina Cristea1,
Carmen Murariu1, Gabriel Sandu2,
(336) Predictive value of Gabriela Blanaru3, Mircea Ioan Popa1
1
attachment style and University of Medicine and Pharmacy Carol
perceived social support for 2
Synevo, Bucharest, Romania
the onset of somatic 3
Emergency Hospital for Children Marie S. Curie,
Bucharest, Romania
complaints in adolescents
Ovidiu Popa Velea, Carmen Trutescu, Objectives: Antibiotic resistance is a world-
Liliana Diaconescu, Ioana Cioca, wide problem. Some of the older antimicrobial
drugs come back as therapy of infections caused
Alexandra Mihailescu by multiple resistant organisms. Our aim was to
University of Medicine and Pharmacy Carol analyze colistin resistance of Gram-negative ba-
Davila, Bucharest, Romania cilli strains isolated from pediatric pathology in
one hospital in Bucharest.
Objective: To investigate the association be- Methods: Strains of Gram-negative bacilli ob-
tween attachment style, perceived social support tained from processing urine cultures, blood cul-
and the onset of somatic complaints in adoles- tures and tracheal aspirates were studied. Sam-
cents referred for psychiatric evaluation. ples were processed as soon as they were taken,
Method: Participants included 55 adolescents according to internal working procedures. For
(13-18 years old), sex ratio females: males 2.44: cultures we used conventional culture media and
1, referred to the Obregia Psychiatric Hospital P plus pediatric bottles, with incubation in the
Bucharest for affective disorders (depressive epi- BACTEC system. Bacterial identifications were
sodes, anxiety disorders, reactions to severe carried out by mass spectrometry (Maldi Biotyp-
stress, adjustment disorders). The somatic com- er). Antibiotic susceptibility testing was performed
plaints were assessed through one administration using NM 40 (MicroScan WalkAway) panels,
of the GBB Questionnaire, while their perceived while respecting the EUCAST recommendations.

ABSTRACTS
Results: From the urine cultures, a total of diagnosis, and as such diagnosis can only be
111 strains were isolated:E.coli 63.9% (n =71), sometimes established postmortem.
Klebsiella pneumoniae 27.1% (n = 30) and Pseu- Objective: The aim of the pilot study present-
domonas aeruginosa 9% (n= 10). Colistin resis- ed here is to evaluate whether a predefined set of
tance of these isolates was 33.3% for Klebsiella proinflammatory markers are differentially ex-
pneumoniae (n= 10) and 0% for E. Coli and pressed at mRNA level in chronic myocarditis,
Pseudomonas aeruginosa. compared to cases without a histopathologically
From blood cultures Klebsiella pneumoniae (n proven cardiac pathology.
= 10) was isolated; all strains were sensitive to Methods: The study was initiated in two cases
colistin. From tracheal aspirates we isolated: of myocarditis and two controls, identified at au-
Klebsiella pneumoniae 33.9% (n = 42) and Pseu- topsy. The expression of inflammatory genes was
domonas aeruginosa 66.1% (n =82). Colistin re- quantified using the MLPA method (Multiplex Li-
sistance of Klebsiella pneumoniae isolates was gation-Dependent Probe Amplification). MLPA
50% (n= 21). In the case of Pseudomonas aerugi- allowed the relative quantification of more than
nosa resistance was 31.7% (n= 26). Although 40 mRNA molecules in a single reaction.
gender distribution shows a predominance of Results: Compared to the two controls, the
positive cultures for males 57.3% (n=47) versus myocarditis probes have shown an increase in the
42.7% (n= 35) in women, the percentage of co- expression of genes coding for proteins included
listin resistance was higher for strains isolated in the following functional classes: coagulation
from females 42.8% (n =15) compared to 23.4% factors (F3 and THBS1), transcription factors
(n = 11) from males. (NFKBIA), growth factors (MYC and PDGF), and
Conclusions: Colistin resistance of Gram- chemokines (MMIF).
negative bacilli in this study varied from 0% to
Conclusions: MLPA has been proven to be a
50% depending on the isolates and the patho-
sensitive, robust and fast method for molecular
logical products examined. We want to further
screening in nonspecific chronic myocarditis. Fur-
evaluate the differences between the data ob-
ther studies should validate the results and iden-
tained by us and some of the literature reports as
tify their usefulness in legal medicine.
well as to detect some molecular mechanisms
involved in resistance/sensitivity ratio for Poly-
myxin E (Colistin) in the current therapeutical ap- (358) Screening for cystic
proach.
echinococcosis in rural
(355) Gene expression of areas from Arges county
inflammatory markers results from HERACLES
involved in sudden (cardiac) project
death associated with Gabriela Loredana Popa1, Mircea Ioan
Popa1, Cosmin Alexandru Popa1, Corina
chronic myocarditis
Constantin2, Denisa Janta1, Bogdan
Cristian Bogdan Iancu1, Irina Rentea2, Mastalier1, Patricia Mihailescu3, Marius
Sorin Hostiuc3, Valentina Nastasel4, Petrutescu1, Carmen Michaela Cretu1
Roxana Ivascu2, Mugurel Constantin 1
Rusu2 Davila, Bucharest, Romania
2
1
National Institute of Legal Medicine Mina Colentina Clinical Hospital CDPC, Bucharest,
Minovici, Bucharest, Romania Romania
3
2
University of Medicine and Pharmacy Carol FP7 Project HERACLES Grant 602051/2013
3
Romania Division of Anatomy, Bucharest, Background: Cystic echicococcosis (CE), a
Romania chronic and complex parasitic disease, continues
4
Faculty of Dental Medicine, University of to be endemic in Eastern Europe and represents a
Medicine and Pharmacy Carol Davila, Bucharest, major public health problem. The aim of the cur-
Romania rent study is to assess the current epidemiology of
CE in Romania, identify its incidence and preva-
Asymptomatic chronic myocarditis is a rare lence, understand the main causes of its distribu-
cause of sudden (cardiac) death. In this case, min- tion and outline the need for adequate measures
imal or absent symptoms do not contribute to the to fight this disease.

ABSTRACTS
Methods: As part of HERACLES collaborative interactions. Cell adhesion, spreading and migra-
project (Human cystic Echinococcosis ReseArch tion play an important part in physiological pro-
in Central and Eastern Societies), we organized cesses, such as embriogenesis, but also in repair
several field activities in rural endemic areas from mechanisms (wound healing) and in pathology
Romania. We present here data collected from (cancer). Real time studies of live cells allow the
Arges county, where our work consisted in clini- observation of cellular dynamics over long peri-
cal, imagistic and laboratory screening for CE, ods of time, in order to obatin a better under-
during one week of June 2015. We used four ul- standing of the complexity of biological functions.
trasound equipment and collected blood samples During the last two decades, many techniques
from suspected CE and control cases. We also have been developed and improved for real time
emphasized on raising awareness on CE, by tell- cell studies, especially for live cell imaging (wide
ing people about the disease and teaching them field microscopy, confocal microscopy, FRAP,
how to prevent it. FLIP, FRET, etc.). Other methods, that dont use
Results: The participants included in the microscopy techniques or fluorescent markers,
screening were selected from four rural areas (vil- have also been developed: SPR (Surface Plasmon
lages) in Arges: Slanic (184), Domnesti (630), Resonance), impedance spectroscopy. This paper
Berevoieti (292), Aninoasa (471). From a total of aims to present the advantages and disadvantages
1577 persons in the studied population, we de- of using two real time monitoring devices a time
termined 22 positive cases of CE (1.4%), with a lapse videomicroscope (BioStation IM) and
gender ratio men: women of 1:4.5 (4 males and equipment that measures the electrical imped-
18 females). The most frequent localization of the ance of the cell layer in real time (xCELLigence)
cysts was in the liver. We will present data on in investigating the effect of UVA radiation on
cysts` characteristics, including dimension, WHO cultures keratinocytes.
classification and co-morbidities. The patients
with suspected cases of CE have been invited to (367) Psychological and
Colentina Clinical Hospital to confirm the diagno-
sis and receive personalized treatment. hormonal markers of
Conclusions: National reports are needed in distress in healthy
order to determine the real epidemiological sta-
tus of CE. This neglected disease is both prevent- undergraduate medical
able and treatable, due to the recent medical ad- students
vances. However, in order to develop efficient
prevention and control programs, screening ac- Alexandra Mihailescu, Liliana
tivities should be performed in the endemic com- Diaconescu, Alexandra Totan,
munities, considering also all the related factors. Ovidiu Popa-Velea
Moreover, screening for CE in rural areas is ben-
eficial for the population included in the study, as
it can reveal other pathologies and help people
who do not count on a high-quality healthcare
Objectives: To assess the prevalence of high
system.
perceived stress, self-reported depression and
self-reported anxiety, and their association to hor-
(362) The use of real time monal markers of distress (salivary cortisole) in a
methods for in vitro studies sample of undergraduate healthy medical stu-
dents, being subject of academic stress.
Cristina-Mariana Niculite1, Andreea Methods: The participants were 95 under-
Oana Urs2, Alexandru Florea2, Sabina graduate medical students (age = 19.02, SD =
Serbu1, Marina Nechifor2, Mircea Leabu2 2.71) in the University of Medicine and Pharma-
cy Carol Davila Bucharest, randomly selected
1
National Institute of Pathology Victor Babes, from the first year students and about to confront
Bucharest, Romania themselves for the first time with academic stress
2
University of Medicine and Pharmacy Carol (in the form of the first exam session). Instruments
Davila, Bucharest, Romania used were the measurement of salivary cortisole
(24h before the exam) and a single administration
A variety of biological processes require inter- of the Perceived Stress Scale (PSS), the Zung Self-
actions between cells and their extracellular ma- rating Anxiety Scale (ZSAS) and the Zung Self-
trix, as well as the adequate regulation of these Rating Depression Scale (ZSDS).

ABSTRACTS
Results: The mean of the salivary cortisole

values was situated between 6.91 ng/ml (men)
and (7.04 ng/ml) (women), with a trend to in-
crease in mild and severe depression (cortisole
mean for the whole sample: for ZSDS 48: 7.48
ng/dL; for ZSDS <48: 6.88ng/dL).
46.42% of the subjects showed higher per-
ceived stress. 75% of all students obtained scores
that suggest pathological anxiety, with a higher
frequency in female students. In contrast, male
participants had a higher frequency of depres-
sion. Perceived stress was more prevalent
(58.23%) in male students and correlated to both
anxiety (p <.001) and depression (p <.05). High-
er values of cortisole were significantly correlated
(p <.05) to perceived stress only in male subjects.
Conclusions: These data suggest a high prev-
alence of perceived stress in medical students,
which is expressed merely as anxiety and, more
rarely, as depression. Even if depression is not as
prevalent as anxiety, it has strong hormonal cor-
relates, in the form of the increase of salivary cor-
tisole. Male subjects seem more hormonnally
sensitive to perceived stress. Efforts should be
made for prevention of stress amongst first year
students, in order to prevent the onset of clinical
anxiety and depression and alteration of the hor-
monal homeostasis.

D ENTAL M EDICINE
(133) Correspondence Conclusions:

The findings of this study indicate that com-
between S stage on the pletion of root formation of mandibular canine,
hand-wrist radiographs and prior to apical closure may be a maturity indicator
of the pubertal growth period.
mandibular canine stage G Human growth shows considerable variation
on panoramic X-rays in the chronological ages for individuals who
reach similar developmental events.
Elena Galan, Angelica Bencze, Andreea Because of the wide variation among individ-
Raluca Hlatcu, Ecaterina Ionescu, uals in the period of the pubertal growth spurt,
Viorica Maria Milicescu chronologic age cannot be used for the evalua-
Department of Orthodontics and Dentofacial tion of growth potential.
Orthopedics, University of Medicine and In average, pubertal growth spurt occurs near-
Pharmacy Carol Davila, Bucharest, Romania ly 2 years earlier in girls than boys
Further research is required on a larger sam-
Hagg and Taranger have designed a method ple.
using the hand-wrist radiographs to correlate cer-
tain maturity indicators to the pubertal growth (137) Microscopic aspects of
spurt. subgingival plaque in
The sesamoid bone is a small nodular bone,
most often present embedded in thumbs ten- patients with chronic
dons area. S stage usually corresponds to the pu- periodontitis, before and
bertal growth spurt( ONSET-PHV).
Most authors agree that peak height velocity after the initial treatment
follows adductor sesamoid appearance by ap- Gabriela Bancescu, Mihai Ciocardel,
proximately 1 year.
Adrian Bancescu, Raluca Papagheorghe,
More than one study shows that the canine
stage G (proposed by Demirjian) for both sexes Daniela Caruntu
coincides with the S stage, and indicates the on- University of Medicine and Pharmacy Carol
set of a period of accelerating growth (Chert- Davila, Bucharest, Romania
kow-1979, Coutinho, Buschang, Miranda-1993).
Objectives: The aim of this study is to verify Objectives: Comparison of microscopic as-
the possibility of correspondence between S stage pects of the subgingival plaque smears in patients
on the hand-wrist ra-diographs and the left man- with chronic periodontitis with deep pockets be-
dibular canine stage G on panoramic X-rays. fore and after initial periodontal therapy, based
Methods: 120 hand-wrist radiographs were on local mechanical treatment and antibiotic ad-
analyzed, for 108 patients with ages between ministration.
6-18. For this study were selected 24 subjects ( 12 Method: Subgingival plaque samples were
girls and 12 boys). The selection criterion was the collected using 0.001 ml disposable loop from
presence of S stage on the analyzed hand-wrist deep periodontal pockets in 16 patients with
radiographs. chronic periodontitis at a private dental practice
For subjects in the study group they were ana- in Bucharest, from September to December
lyzed panoramic X-rays, performed in the same 2014. Gram and Giemsa stained smears per-
date with the hand-wrist radiographs with S stage formed from subgingival plaque before periodon-
present. It was evaluated the degree of mineral- tal treatment were marked as smears-1 group.
ization of mandibular left canine according to The smears-2 group consisted of Gram and Gi-
Demirjians method. emsa stained smears done one week after a 14
Results: In this study we have found corre- day-period of oral administration of amoxicillin
spondence between S stage on the hand-wrist and metronidazole, in addition to scaling and
radiographs and the left mandibular canine stage root planning. The microscopic interpretation
G on panoramic X-rays. was based on the semiquantitative scoring sys-

ABSTRACTS
tem: 1+ to 4+ for polymorphonuclears and mi- cation. Stata 11IC (version 2009) was used for
crobial flora, and the relative proportion of Gram- data analyses. To test the influence of the year of
positive and Gram-negative bacteria. study on their oral health attitudes and behavior,
Results: The smears-1 from 15 patients Pearson Chi-squared Test was used.
showed high amount of polymorphonuclear leu- Results: Tooth brushing twice per day and use
kocytes and microflora with various morphotypes of dental floss were scored significantly higher for
(e.g. spiral-shaped bacteria, Gram-negative ba- the senior-year students (96%, respectively 84%,
cilli and coccobacilli, Gram-negative diplococci, p=0.001) versus junior-year (85%, respectively
Gram-positive cocci in pairs, chains and clusters, 48%, p=0.000). Regarding the diet, consumption
Gram-positive bacilli and branched/non-branc- of cariogenic food and carbonated drinks were
hed filaments). Gram-negative bacilli and spiro- significantly higher for the first year students
chaetes were predominant. In all 15 cases, (p=0.001). The same group was associated with
smears-2 showed inflammatory cells and flora the absence of preventive actions after meals be-
reduction compared to the microscopic aspect of cause of the lack of knowledge in this respect.
smears-1 of the same patients. In one patient, it Conclusions: Even if the method used in this
was observed in both smears-1 and 2: a mono- survey has some limitations (dental health behav-
morphic flora showing Gram-negative reniform ior is self-reported and subjects can overestimate
diplococci, within leukocytes. Frequent tropho- the proper behavior or underreport the negative
zoites of Entamoeba were detected in 10 cases of behavior), the results showed that oral health be-
generalized chronic periodontitis, in smears-1. havior and treatment demands of students in the
After therapy, the amoebae were not detected in late phases of their studies reflect the importance
smears-2 in 3 cases. In 7 cases the trophozoites of specialized years of dental education gained
number recorded a significant decrease. during the faculty. The expertise gained may pos-
Conclusions: The decrease in polymorpho- itively influence the oral health behavior of senior
nuclears and flora (especially the spirochaetes) in students, making them able to change unhealthy
smears-2 suggested a good patient response to behaviors of their future patients.
the initial periodontal therapy. Further research is
necessary to assess the role of protozoa in peri-
odontal pathology. (232) The relationship
between positive
(185) Changes in oral psychological well-being,
health-related behavior academic demand and
among first and last grade performance: a prospective
dental students study on dental students
Ruxandra Sfeatcu, Mihaela Adina Cristina Teodora Preoteasa, Anca
Dumitrache, Gabriela Lupusoru, Mircea Axante, Anca Diana Cristea
Lupusoru, Mariana Caramida Faculty of Dental Medicine, University of
University of Medicine and Pharmacy Carol Medicine and Pharmacy Carol Davila, Bucharest,
Davila, Bucharest, Romania Romania
Objective: This study was to analyze the influ- Objectives: This study evaluated the change
ence of the professional education on the oral of positive psychological well-being of second
health behavior of senior students, as compared year dental students across the academic semes-
to junior students from the Faculty of Dental ter, in regard to the different levels of academic
Medicine, Carol Davila University of Medicine demand (1) and the relation between academic
and Pharmacy. performance and dental students positive psy-
Methods: A self-administered questionnaire chological well-being (2).
was applied for 293 students, divided into two Method: A prospective study was conducted
groups: 156 first grade students (65.4 % females, on second year dental students from Carol Davila
mean age 192.59); and 137 last grade students University of Medicine and Pharmacy. Data was
(32.8% males, mean age 25 1.82). The hypoth- collected during the second semester of 2014-
esis of this study was that the level of the oral 2015 academic year, three times during the
health behavior is different between the two teaching period (in the beginning of the semester
groups, is improved with increasing level of edu- during a period of coursework without assess-

ABSTRACTS
ments, after a mandatory intermediate written bracket bonding with light-cured composite resin
theoretical examination, and after a mandatory (CR) vs. light-cured glass ionomer cements (GIC).
practical examination), and one time during the Methods: An in vivo observational study was
semester evaluation period (after a final exam). conducted on a convenience sample formed by
Positive psychological well-being was assessed us- patients with previous fixed orthodontic appli-
ing WHO-Five Well-being Index (WHO-5). Stu- ances, bonded either with glass ionomer cement
dents academic performance was assessed (GIC) or composite resin (CR), and patients with-
through their grade-point average, attendance to out previous orthodontic appliances (WOA). The
all final exams, and ability of passing all final ex- VITA EasyShade intraoral spectrophotometer was
ams. used for assessment of tooth colour of maxillary
Results: One hundred and forty-six dental incisors, canines and first premolars. The differ-
students were included. Repeated ANOVA ence of lightness (L*), Chroma (C*), hue (h*),
showed a significant decrease of the level of posi- red/green coordinate (a*), yellow/blue coordi-
tive well-being over the academic semester nate (b*), and total colour difference (E*) be-
(mean of WHO-5 of 66, 65 and 61 during teach- tween the cervical and middle third of the labial
ing period, and 56 during semester evaluation surface was analysed.
period; p<0.001), which was concordant with Results: Thirty-three patients, nine in which
the progressive increase of academic demand in orthodontic brackets were bonded with GIC, thir-
this time span. Thirty-one (21%) of dental stu- teen in which orthodontic brackets were bonded
dents in in the beginning of the semester, and fif- with CR, and eleven without previous orthodon-
ty-nine (40%) dental students in the semester tic appliances were included, 264 teeth being
evaluation period, were recommended to be measured. Greater similarity with natural teeth
tested for depression, according to WHO-5 inter- (i.e., teeth without previous orthodontic treat-
pretation. Students with better performance in ment) was observed when bracket bonding was
the semester evaluation period had higher posi- done with GIC for L* (GIC:1.50; CR:2.05;
tive well-being levels at the beginning of the se- WOA:1.44), and when bracket bonding was
mester, during which focus is on teaching basic done with CR for E* (GIC: 3.93; CR: 5.81;
theoretical knowledge and practical skills of the WOA: 5.51). These results suggest that by bracket
semesters courses, and examinations are scarce. bonding with CR the lightness differentiation be-
Conclusions: Based on this research, consid- tween middle and cervical third of labial surface
ering its limitations, a relationship between posi- of the tooth increases. Similar results after bracket
tive well-being, academic demand and academic bonding with GIC and CR, but rather different
performance is suggested. Therefore, making from the ones of teeth without previous fixed
dental students aware of the risks involved by the orthodontic appliances, were found for C*
lowering of the level of positive well-being, and (GIC:2.25; CR:2.38; WOA:3.43), h* (GIC:-
implementing interventions for sustainment and 1.58; CR:-1.92; WOA:-2.80), a* (GIC:0.78;
enhancement of well-being in university settings, CR:0.71; WOA:1.10) and b* (GIC:2.27;
seem beneficial on short- and long-term, at a CR:2.48; WOA:3.42).
both personal and professional level. Conclusions: Considering studys results and
limitations, there is suggested that orthodontic
(233)Composite resin vs. bracket bonding associates changes of the distri-
bution of tooth color, which seem to be related to
glass ionomer cement for the type of bonding material used. Prospective
orthodontic bracket studies are needed in order to better quantify the
extent of these colors alteration, identify best
bonding an in vivo treatment alternative in terms of lowest side effect
spectrophotometric study in this direction, considering also acknowledg-
ment on their perceptibility by the lay person and
Cristina Teodora Preoteasa, Elena impact on the treatment outcome.
Preoteasa
Romania
Objectives: To evaluate the differences in the

distribution of tooth colour after orthodontic

ABSTRACTS
(283) New digital uates in dental medicine, should be an integrated

part of the modern educational strategy.
technologies approach in
prosthetic planning and (390) New miniplate
rehabilitation of complete involved in favorable
edentulism distribution of the
Marina Melescanu Imre, Ana Maria perifocale forces at a
Cristina Tancu, Mihaela Pantea mandibular angle fracture
Teodora Pituru, Claudiu Gudas, Silviu
Romania Pituru, Octavian Dinca, Alexandru
Bucur
Objectives: Since the introduction of dental Faculty of Dental Medicine, University of
implants, the treatment of full edentulism has Medicine and Pharmacy Carol Davila, Bucharest,
evolved from conventional complete denture to Romania
implant-supported prosthetic restorations (over-
dentures, Fast & Fixed, All on 4, fixed restora- Introduction: A new miniplate with different
tions). More recently, the new era of digital tech-
design and reduced thickness compared to those
nologies in dentistry has brought important
used in current practice has been designed with a
progress in treatment planning and improved fi-
FEA model and verified on experimental stage.
nal results predictability.
The shape of the new miniplate provides superior
The aim of this study is to explore the advan-
stability of bone fragments to bar type plates used
tages offered by the digital technologies to the
in current practice.
prosthetic treatment of the complete edentulous
Methods: The first stage, the development of
patient.
the design, was carried out using 3D FEA of a hu-
Method: In order to select the most suitable
man mandible with angle fracture. The fractured
treatment alternative (over-denture / removable
segments were fixed with the new miniplate near
implant-supported restoration / fixed prosthetic
the upper border of the mandible. The load con-
restoration on implants) for a bi-maxillary fully
sidered was 200N applied perpendicular to the
edentulous 76 years old patient a specific proto-
occlusal plane at the position of the incisive teeth.
col was applied, including: a complete clinical
After solving the model with MSC Nastran, the
examination, a set of common imagistic exams
results for displacements and contact forces be-
(panoramic X-Ray; digital photos), a CBCT with a
tween the fasteners and cortical bone or mini-
stent made with radio-opaque teeth. The result-
plate indicated that the goal of the design has
ing imagistic data, combined with functional and
been achieved: the control of direction for fas-
esthetic criteria (provided by clinical tests -
tener reactions and minimisations of these forces
speech, deglutition, anthropometric points, facial
harmony, face-scan analysis, etc.), allow different are immediately near the fracture line.
configurations for implant placement. The experimental stage was aimed towards
Results: A precise and functional treatment verifying the miniplate capability in segments sta-
planning was obtained, on the basis of the pro- bility and bypassing across the fracture line and
cessed imagistic data that were related to clinical the required internal loads developed in the
aspects. The decision on the optimal implant- mandible during biting. This stage was carried out
supported restoration (mobile versus fixed) was in three series of load tests and was conducted on
made by analyzing clinical and digital data, thus sheep mandibles. Two CNC miniplates were ma-
allowing also a minimally invasive implant place- chined to specification from Ti6AlV4.
ment. The new miniplate has the ability to transfer
Conclusions: The new digital technologies fa- away from the bone fracture line the internal
cilitate the prosthetic treatment planning in com- forces developed during biting.
plete edentulism cases, providing data for per- Results: During the entire testing program it
forming a precise implant placement and for was noticed that both miniplates have good mal-
obtaining a proper implant-supported restoration leability, fact shown by their ability to confirm
(fixed or removable, provisional or final). Consid- closely to the surface of the cortical when the
ering these aspects, a thorough approach to digi- screw were tighten to the customary torque val-
tal technologies, both by students and post-grad- ues (70Ncm).

ABSTRACTS
The miniplate geometry is effective in deter-

mining the direction and magnitude of the forces.
Conclusions: The aim of creating this new
miniplate is to allow the premises for a better
healing. This healing is possible by directing the
direction and magnitude of forces developed in
the interface between the fixing screw and corti-
cal bone during mastication and occlusion.

P HARMACY
(24) Phytochemical vegetable juice. Ascorbic acid influence the anti-

radicalar activity of the extracts, but its presence
research regarding frozen is not determinant. The presence of other com-
juices of fruits and pounds with antiradicalar activity, like flavonoid
heterosides, anthocyanidins or betaine (mentio-
vegetables ned by scientific literature) may be responsible for
Ioana Nencu, Lidia Maria Popescu, the antiradicalar activity of the extracts.
Conclusion: Ascorbic acid was found in the
Cerasela Elena Gird, Corina Ionita,
frozen fruit juices, but not in the fruit form vege-
Ligia Elena Dutu, Teodora Costea tables. The presence of ascorbic acid influence
Faculty of Pharmacy, University of Medicine and antioxidant activity of the extracts, but is not de-
Pharmacy Carol Davila, Bucharest, Romania terminant.
Objective: The identification and quantitative (36) Synthesis, structure

determination of ascorbic acid from frozen juices
of raspberry, strawberries, white and red beet- elucidation, characte-
root. rization and anti-
Methods: The raw material was harvested staphylococcal activity of
from ecologic cultures, in Berceni village, Ilfov
County, Romania in 2015. The fruits were har- new thioureas derivatives
vested in July and the vegetable were collected in
Carmellina Daniela Badiceanu, Carmen
September. The juice was obtain shortly after har-
vest, using mechanical squeezer (in order to pre- Limban, Constantin Draghici, Mariana-
serve the ascorbic content) and frozen at - 18C Carmen Chifiriuc, Cristina Delcaru,
for 2 months. Prior to chromatografic and spec- Diana Camelia Nuta
trophotometric analysis, the juice was stored for a
Faculty of Pharmacy, University of Medicine and
day at 4-5C.The content of ascorbic acid was
determined by chromatografic means, using an
HPLC MD-2015 with UV detector, an inverse
Objectives: Staphylococcus aureus is the
phase and a gradient system of solvents. The cali-
principal hospital pathogen that is becoming in-
bration curve has five points and is linear between
creasingly virulent and resistant, developing a de-
13.20 mcg/mL 246 mcg/mL. The antiradicalar
fense mechanisms against most antibiotics.
activity was determined using the reducing ferric The objective of this study was the synthesis of
assay. In this method, the antioxidant compounds seven new thioureas derived from 2-thiophe-
reduce potassium ferricyanide (Fe3+) to ferrocya- neacetic acid, the characterization on their physi-
nide (Fe2+), which reacts with ferric chloride to cal properties (melting point, solubility) and the
form ferric ferrous complex. The ferric ferrous antimicrobial testing by quantitative methods on
complex absorbance is directly proportional with Staphylococcus aureus ATCC 25923 and Staphy-
the extract reducing power. The results were ex- lococcus aureus ATCC BA 1026 in order to iden-
pressed as g/mL extract that provide 0.5 of ab- tify the most active compound.
sorbance (EC50). Methods: The compounds are resulting from
Results: Ascorbic acid was identified in the a 2-step synthesis, finally being prepared by the
fruits juices, but not in the beetroot juices. The reaction of 2-thienyl-isothiocyanate with various
quantification of the ascorbic acid was possible primary aromatic amines. They are characterized
only in the strawberry juice (73.51 mcg/mL). In by their spectral (NMR, IR) properties.
the raspberry juice although, the ascorbic acid For the antimicrobial activity determination,
was identified, its quantity was below the method the seven thioureas derivatives were evaluated by
detection limit. The higher antioxidant activity their Minimal Inhibitory Concentration (MIC) val-
was found for strawberry juice and the lowest for ues using the microdilution procedure against the
white beetroot juice. Red beetroot juice has a Staphylococcus strains.
higher antiradicalar activity than raspberry, al- Results: We synthesized and analyzed seven
though ascorbic acid was not identified in the new thioureas derived from 2-thiopheneacetic

ABSTRACTS
acid, which were characterized by phisico-chem- of the synthesized compounds exhibited moder-
ical and spectral methods. We put into evidence ate antifungal activity against Candida albicans.
the identity and purity of these compounds. Conclusions: The amide derivatives may be
The new thiourea derivatives proved to have promising leads for the development of new anti-
anti-staphylococcal activity with MIC values of fungal agents. Their activity was correlated with
0,25 and 0,31g/ mL. structural aspects, pointing out the benefit of
Conclusions: From the antimicrobial study it methyl or methoxy substitution on benzoyl moi-
was noted that N-(2 trifluoromethylphenyl)-N-(2- ety.
thienyl)-thiourea and N-(4 trifluoromethylphenyl)-
N-(2-thienyl)-thioureas, have been the most ac- (55) New
tive on Staphylococcus aureus strains.
2-((4-chlorophenoxy)
(44) Research concerning methyl)-N-
the development of new (arylcarbamothioyl)
amide antifungal agents benzamides: synthesis and
Diana Camelia Nuta1, Carmen Limban2, CNS pharmacological
Mariana Carmen Chifiriuc3, Constantin evaluation
Draghici1, Carmellina Daniela Cornel Chirita, Alexandru Vasile Missir,
Badiceanu2 Carmen Limban, Laurentiu Morusciag,
Faculty of Pharmacy, University of Medicine and Carmellina Badiceanu, Simona Negres,
Pharmacy Carol Davila, Bucharest, Romania Cristina Elena Zbarcea, Paula Burciu,
Diana Camelia Nuta
Objective: Knowing that the frequency of
fungal infections and also the resistance to the Faculty of Pharmacy, University of Medicine and
used antifungal drugs have continued to increase, Pharmacy Carol Davila, Bucharest, Romania
the development of new molecules is still neces-
sary in order to ensure a successful clinical treat- Objectives: We present the design, synthesis,
ment of opportunistic fungal infections. In this structural characterization and CNS pharmaco-
direction we designed an active amidic structure logical tests of some new 2-((4-chlorophenoxy)
and synthesized a series of novel amide deriva- methyl)-N-(arylcarbamothioyl)benzamides.
tives which were tested as new potential antifun- Methods: These compounds were prepared
gal agents. by reaction of 2-(4-chlorophenoxymethyl)benzo-
Method: The benzanilides which have the ni- yl isothiocyanate with different anilines. Structure
trogen atom derived from an aromatic amine of new compounds has been supported by IR,
substituted by a dialkylaminoalkyl chain and a NMR spectral analysis and elemental analysis.
(un)substituted benzoyl radical are obtained as We tested the motor activity for 80 NMRI
hydrochlorides having the advantage of good wa- male mice, in order to select the animals for re-
ter solubility, a favorable element subsequent to search. We formed six groups of twelve mice. The
biological tests. All the obtained compounds were four compounds, named CTC-7CTC-10, were
characterized through proton and carbon nuclear administered p.o. in dose of 100 mg/kg, for seven
magnetic resonance spectroscopy, infrared spec- days. As reference drug, we used sulpiride 50 mg/
troscopy, and elemental analysis kg, p.o. We performed pharmacological tests af-
The antifungal activity testing was conducted ter 1 and 7 days of treatment:
through qualitative methods (disk diffusion) and - the horizontal and vertical motor activity
quantitative (microdilution method) and are ex- test, with Activity cage Ugo Basile, Italy;
pressed by values of minimum inhibitory concen- - the suspended + maze, Ugo Basile, for eval-
trations (MIC, g/ mL) using Candida albicans uation of the effect on mice anxiety;
strains. - the forced swimming test (FST)/ the tail sus-
Results: We synthetized 6 new benzanilides, pension test (TST), for antidepressant action eval-
derived from 3-chloroaniline, which were ana- uation.
lyzed in terms of physicochemical and spectral Results: We obtained new benzamides with
(1H-NMR, 13C-NMR, FT-IR) properties to con- high purity and good yields, and their structures
firm the structure of synthesized molecules. Pre- were confirmed by elemental analysis, IR, 1H-
liminary antifungal activity test showed that some NMR and 13C-NMR. The new compounds have

ABSTRACTS
been characterized by their physical constants amines. The structures of the newly synthesized
such as melting point and solubility. The com- compounds were confirmed by IR and NMR
pounds chemical structures were in full agree- spectroscopic and elemental analyses. The com-
ment with the proposed structures. pounds presented good antiproliferative effects
The four benzamidic compounds had no sig- and apoptosis inducting properties. The authors
nificant influence on motor activity. In suspended acknowledge the financial support offered by Ro-
+ maze, the compounds increased the number manian National Authority for Scientific Research,
of entries in open arms, comparing the control UEFISCDI, through grant PN-II-RU-TE-2014-4-
group, the effect of CTC-8 being 94.87% after 1670, no. 342/2015.
acute administration (p<0.05; ANOVA + Bon-
ferroni posttest). The same compound produced (93) Interactions between
an increase of number of exits outside open arms,
with 31.75% comparing the control group. These some herbs and
results can sustain a potential anxiolytic effect.All conventional drugs
substances reduced the immobility time in FST
after acute administration, the antidepressant ef- Ligia Elena Dutu, Cerasela Elena Gird,
fects being between 10.58-23.45%. CTC-9 had Maria Lidia Popescu, Ioana Nencu,
the most intense action. In TST, the only com- Teodora Costea
pound that significantly reduced the immobility
time was CTC-8, the effect being 24.94% Faculty of Pharmacy, University of Medicine and
(p<0.05, t Student). Pharmacy Carol Davila, Bucharest, Romania
Conclusions: The new compounds have a
high potential of CNS actions, proving some sig- Nowadays, more and more people use phyto-
nificant effects in pharmacological tests that we preparations (including herbal medicines and nu-
performed. For any further research, the interest tritional supplements) to treat various diseases,
compounds seem to be CTC-8 and CTC-9. frequently as an adjunctive therapy. Phytoprepa-
rations association with convention drugs may
cause a series of interactions.
(71) Synthesis of new Objective: The present paper aims to draw
pyrazole derivatives as AKT attention to the possible risks that may occur in
concomitant use of phytopreparations and con-
inhibitors vention drugs, and to recommend the therapeu-
George Mihai Nitulescu, Constantin tic attitudes.
Draghici, Bruno Stefan Velescu, Method: A number of herbal drugs that are
commonly used in therapy were selected. Scien-
Georgiana Nitulescu, Octavian Tudorel tific data about their chemical compositions,
Olaru therapeutic uses and interactions with conven-
Faculty of Pharmacy, University of Medicine and tional drugs (based on preclinical and clinical
Pharmacy Carol Davila, Bucharest, Romania studies) were searched and systematized.
Results: Scientific date about the following
Akt, known also as protein kinase B, functions herbal drugs were collected: Echinaceae radix et
as a pivotal point of converging signaling path- herba (Echinacea), Ginkgonis folium (Ginkgo),
ways involved in cell growth, proliferation, apop- Ginseng radix (Ginseng), Hyperici herba (St.
totis, and neo-angiogenesis and has been validat- Johns wort), Liquiritiae radix (Liquirice), Menthae
ed as a therapeutic target in many cancer types. folium / herba (Peppermint), Medicaginis herba
The development of inhibitors of PIP3/PH do- (Alfalfa), Plantaginis ovatae semen (Ispaghula),
main binding of Akt emerged as an alternative Schisandrae fructus (Schisandra), Terminaliae ar-
strategy. PIT-1, and the more soluble dimethyl junae cortex (Arjuna) s.a. Many of pharmacologi-
analog, DM-PIT-1, inhibit Akt activities, and cal studies were related to interactions of these
thereby decreasing tumor growth without signifi- herbs and their extracts with anticoagulants (war-
cant general toxicity. The objective of the study farin and related drugs) and immunosuppres-
was to design and synthesize a series of new pyr- sants.
azole thiourea chimeric derivatives as potential St. Johns wort was appeared to be one of the
anticancer agents targeting the PIP3/PH domain most studied vegetal species. Due to its composi-
based on the PIT-1 scaffold. The target com- tion, including naftodiantrones (hypericines), pre-
pounds were obtained using basic organic syn- nylated-phloroglucinols (hiperforine), polyphe-
thesis methods starting from various pyrazole nolcarboxilic acids (caffeic acid derivatives),

ABSTRACTS
flavones (kaempferol, quercetin and luteolin het- oral bioavailability and therapeutic activity of
erosides), carotenoids and tannins, this herbal mebendazole.
drug is a well-known antidepressant, cholecysto-
kinetic and healing agent. Experimental and clini- (175) Microbicidal and
cal reports have revealed dangerous interactions
between St. Johns wort extracts and some gen- antibiofilm activity of new
eral anaesthetics, antiepileptics, benzodiaze- dibenzo[b,e]thiepine
pines, calciu-channel blockers, cardiotonics, cen-
trally acting muscle relaxants, anticancer agents, derivatives
hormonal contraceptives, anticoagulants, immu- Camelia Elena Stecoza, Miron Teodor
nosuppressants and antifungals.
Caproiu, Mariana Carmen Chifiriuc
Conclusion: Associating phytopreparations
(herbal medicines and nutritional supplements) Faculty of Pharmacy, University of Medicine and
with convention drugs can be lifethreatening. Pharmacy Carol Davila, Bucharest, Romania
Because of this, some combinations should be
avoided, and in other cases the dose adjustment Objectives: The rising tide of antimicrobial
and monitoring of treatment needed. drug resistance has nullified the effects of many
conventional agents. The prognosis is worsened
by the formation of bacterial biofilms on the bio-
(163) Research concerning materials used in medicine due to their pheno-
the improvement of typic resistance, even if the component cells test-
bioavailability of ed in suspension are susceptible to some
antibiotics Therefore, there is a particular interest
mebendazole to develop new strategies to control the infectious
Firas Ghafil, Valentina Anuta, diseases. Recent studies have shown the antimi-
crobial activity of a number of non-antibiotic
Iulian Sarbu drugs, not only against planktonic cells, but also
Faculty of Pharmacy, University of Medicine and on biofilms. Among the different chemical com-
Pharmacy Carol Davila, Bucharest, Romania pounds reported in the literature for their inhibi-
tory activity on microbial growth, the tricyclic
Objectives: Objective of the research was the psychotropic drugs, including dibenzothiepine
increase of bioavailability of mebendazole, in or- derivatives, have been found to exhibit besides
der to assure its effect not only local, but in liver their specific activity, an antimicrobial one. These
and other internal organs also. observations and particularly the antipathogenic
Methods: It were prepared three solid formu- potential of dibenzothiepines reported in our
lations containing croscarmellose, an internally previous works, prompted us to synthesize new
cross-linked sodium carboxymethylcellulose for compounds and to assess their microbicidal and
use as a superdisintegrant in pharmaceutical for- antibiofilm properties.
mulations, in 1%, 2% and 3 %. Tablets were con- Methods: The new compounds, dibenzo[b,e]
trolled using pharmacopeal methods it concerns thiepines and dibenzo[b,e]thiepine-5,5-dioxides,
content in active substance and physico-chemical were synthesized following a multi-stage synthe-
properties. For assay of mebendazole was devel- sis and were characterized by elemental analysis
oped and validated an HPLC method. Bioavail- and spectral studies (1H-NMR, 13C-NMR, IR).
ability was estimated by in vitro release kinetics The antimicrobial activity was performed using
using USP XXIII apparatus 1, in acidic medium reference and clinical microbial strains belonging
plus sodium lauryl sulfate (LSS) and in Fasting Sys- to Escherichia coli, Klebsiella pneumoniae, Aci-
tem Simulating Intestinal Fluid) (FASSIF). netobacter baumanii, Pseudomonas aeruginosa,
Results: Obtained formulations correspond- Staphylococcus aureus, Bacillus subtilis, Candida
ed to compendial conditions for tablets. After 2 albicans and Aspergillus niger species.
hours release kinetics was poor in FaSSIF (around Results: The new compounds exhibited a
10%) and complete in HCl + LSS. Both rate, esti- broad spectrum of antimicrobial activity (superior
mated by initial slope of the release curves, and for the 5.5-doxide derivatives) being effective
extent, defined as maximum release and as Area against a wide range of infectious microorgan-
Under Dissolution Curve (AUC), increased lin- isms, including Gram-negative, fermentative
early with concentration of croscarmelose. strains, Gram positive bacteria and fungi. Some of
Conclusions: Croscarmellose and direct com- the new compounds exhibited microbicidal ac-
pression might be an effective way of improving tivity against the Gram-negative, non-fermenta-

ABSTRACTS
tive A. baumanii. Some of the compounds also film revealed cytotoxicity at higher concentra-
inhibited the ability of these strains to form bio- tions and alterations of the mitosis with modifica-
film on the inert substratum. tions of metaphases, anaphases and telophases.
Conclusions: This paper presents the synthe- Conclusions: Two extractive solutions from
sis, spectral characterization, microbicidal and Polygonum cuspidatum were tested using Triti-
antibiofilm activity of new compounds with cum aestivum bioassay. The research revealed
dibenzo[b,e]thiepine scaffold. The new com- that both extractive solutions are cytotoxic at con-
pounds can be used in the design of more effec- centrations ranging from 0.33 to 5%.
tive inhibitors of biofilm development. Acknoledgements: The authors acknowledge
the financial support offered by Carol Davila
(276) Toxicity evaluation of University of Medicine and Pharmacy Bucharest,
through Research Grant 33883/11.11.2014.
Polygoni Cuspidati Rhizoma
Octavian Tudorel Olaru, Denisa (372) The comparison of in
Margina, Oana Cristina Seremet, vitro dissolution profiles of
George Mihai Nitulescu spironolactone from
University of Medicine and Pharmacy Carol immediate release oral solid
dosage forms
Objectives: Polygonum cuspidatum syn. Fal- Cristina Stecoza, Dumitru Lupuliasa, Ana
lopia japonica (Polygonaceae), a perennial spe-
cies with spreading rhizomes is common in
Andreea Stanescu, Dalia Simona Miron,
Northern Hemisphere. The plant is used in tradi- Flavian Stefan Radulescu
tional Chinese medicine for its anti-inflammatory, University of Medicine and Pharmacy Carol
hepatoprotective and antitumor activities. The Davila, Bucharest, Romania
plant rhizomes contain mainly resveratrol and
emodin, two compounds with proved anticancer Objectives: The new BCS-based biowaiver
activity. In the present work we evaluated the tox- draft guidance issued by FDA in 2015 extended
icity of extractive solutions using a quick, eco- the applicability of the in vitro dissolution meth-
nomical and relevant bioassay using Triticum aes- odologies. At the same time, it introduced new
tivum. The inhibition of the root length and the testing parameters, such as an increased stirring
cell cycle mitosis modification represents together rate of the paddle apparatus, combined with a
an efficient method to evaluate plant extracts an- reduced volume of standard buffer systems of
ticancer potential. 500 mL. The aim of the current work was to eval-
Methods: The extractive solutions were ob- uate the consequences of this new hydrodynamic
tained under reflux from 2.5 g of herbal material context on the dose - dissolution relationship for
and a water-ethanol mixture. The cytotoxicity as- a low solubility drug.
sessment was carried out by determining the Methods: The in vitro dissolution studies of
maximal dilution of the extractive solutions which immediate release solid dosage forms of spirono-
influences the root elongation and the karyoki- lactone (25, 50 and 100 mg strengths) were per-
netic film. The biological material consist of 1 cm formed in compendial buffers (pH=1.2, 4.5 and
long embryonic roots of Triticum aestivum and 6.8, degassed by filtration under vacuum; 500
the root elongation was measured at 24 h during mL). Detailed sampling was performed for 60
the exposure period and the evaluation of karyo- minutes. All tests were conducted on 6 dosage
kinetic film was performed after 24 h of expo- units at 37 degrees Celsius. The amounts of spi-
sure. The bioassay was conducted at 251C, ronolactone dissolved were determined using a
75% RH, in the absence of light, in a plant growth spectrophotometric method. The experimental
chamber (Sanyo MLR-351 H). A negative control data was cross-analyzed with the available data
sample was prepared with distilled water. on the qualitative composition. The compendial
Results: Both extractive solutions inhibited metrics f1 and f2 were calculated for the evalua-
the root elongation at concentrations above tion of in vitro similarity between the several
0.03%, the aqueous solution being more active strengths of the same product of across various
than the ethanolic solution. The concentration- products with the same dose.
inhibition correlation was observed only at lower Results: The mean dissolution profiles were
concentrations. The evaluation of the kariokinetic strongly dependent upon the low solubility of the

ABSTRACTS
drug. Although no obvious plateau region was individual ones. This paper presents the antimi-
observed, after the initial burst in release (10-15 crobial effect of the essential oil obtained from
minutes), the rate kinetics decreased dramatical- the Anethum graveolens fruits encapsulated into
ly. The presence of sodium lauryl sulfate as an ex- two different types of nanoparticulate transport-
cipient accelerated the disintegration, but had ers: liposomes (L) and solid lipid nanoparticles
little if any effect on the quantity of spironolac- (SLN).
tone dissolved at the end of the test. The most Methods: Two different types of nanocarriers
significant differences, as indicated by the values (liposomes and solid-lipid nanoparticles -SLN)
of the compendial metrics, were concluded be- containing the Anethum graveolens oil were pre-
tween the extreme strengths. pared. The lipid film hydration method was used
Conclusions: The reduced volume as pro- for obtaining of the liposomes, whereas for the
posed in the new BCS-based biowaiver draft SLNs lipid mixture emulsification method was
guidance has a considerable impact on the in vi- employed. The influence of various technological
tro comparison between different strengths. parameters on the characteristics (i.e. particle
Moreover, the differences in qualitative composi- size, physical stability, morphological appearance
tion between various products, especially for crit- and encapsulation efficiency) of obtained nano-
ical excipients such as tensioactives, may have a systems was studied.
more pronounced effect on the in vitro dissolu- Results: Using the proposed methods, spheri-
tion. cal particles with sizes ranging between 50 and
430 nm have been obtained. By increasing the
proportion of unsaturated lipid, we mostly ob-
(384) Development and tained a decrease of the particle size and polydis-
characterization of some persity index.
new phytocomplex Encapsulation efficiency was significantly in-
fluenced by the type of lipid, the lipids weight
containing nanoparticles ratio, the hydration temperature, temperature
with antimicrobial activity and duration of the cooling phase, stirring speed,
temperature and time of sonication.
Cristina Dinu-Pirvu, Mihaela Violeta Conclusions: The use of bioactive plant ex-
Ghica, Alina Ortan, Valentina Anuta, tracts may result on one hand the manifestation
Lacramioara Popa of their intrinsic activity, and on the other hand
the enrichment of the nanocarrier lipid matrix
Faculty of Pharmacy, University of Medicine and may allow potentiation of the effect of the encap-
Pharmacy Carol Davila, Bucharest, Romania sulated bioactive compound.
Objectives: Microbial pathology represents a

growing public health threat, as resistance to
(385) Absorption behavior
common bacteria has reached alarming levels, in- of surfactants mixtures at
dicating that many of the available treatment op- interfaces: a contact angle
tions are becoming ineffective. As a direct result,
intensive research is directed in order to develop approach
new approaches to antimicrobial therapy. Investi-
Lacramioara Popa, Mihaela Violeta
gations are directed either towards identifying
new antimicrobial molecules, or development of Ghica, Cristina Elena Dinu-Pirvu,
innovative formulations of known antimicrobial Luiza Tenescu
agents in order to decrease minimum inhibitory Faculty of Pharmacy, University of Medicine and
concentration (MIC), to lower toxicity and antag- Pharmacy Carol Davila, Bucharest, Romania
onize installation of antimicrobial resistance.
Plant extracts represent a viable alternative, and Objective: Wettability of solid surfaces by sur-
their encapsulation into various types of nano- factants plays an important role in surfaces char-
structures can enhance their antimicrobial activity acterization for basic material research, since they
while decreasing toxicity. There are two groups of are known to modify the solid/liquid and liquid/
natural compounds with antimicrobial proper- vapor interfacial tension. The present study de-
ties: the single-acting compounds, with intrinsic scribes a method of absorption behavior evalua-
antimicrobial effect, and phytocomplexes, in tion for surfactants mixtures with application in
which all the component acts synergistic, result- pharmaceutical formulation and optimization of
ing a combined effect greater than the sum of the novel surfactant-based delivery systems.

ABSTRACTS
Methods: An experimental model describing

the equilibrium behavior of surfactants mixtures
at interfaces is presented. Mixed composition of
sorbitan fatty acid esters (Spans) and the corre-
sponding polyoxyethylene (Tweens) were de-
signed and analyzed. Contact angle and surface
energy measurements on coconut/cocoa butter
hydrophobic treated surfaces were performed us-
ing a goniometer CAM 101 with digital camera.
Pendant drop shape method was applied.
Results: Important relationships between the
composition of the surfactant mixtures, the re-
quired HLB value for the hydrophobic material
(coconut/cocoa butter) and the superficial/inter-
facial characteristics were established.
Conclusions: Surfactant mixtures are respon-
sible for changing the interfacial tension at the air/
water and solid/water interfaces and this variation
is related to contact angle and surfactant absorp-
tion. The experimental model proposed could be
applied to explain the absorption behavior of any
component in surfactant-based delivery systems,
drug emulsions, microemulsions design and opti-
mization.

M EDICAL S PECIALITIES
(21) The effect of transition sulin pump therapy. Treatment of HU is challeng-

ing requiring a combination of both strategies,
from basal-bolus to insulin behavioral and educational, along with the use of
pump therapy in a patient technology, such as therapy with continuous insu-
lin pump and online glucose monitoring.
with severe hypoglycemia
unawareness (27) Diagnosis of autosomal
Minodora Betivoiu, Iulia Soare, Luana recessive polycystic kidney
Mintici, Sorin Ioacara, Simona Fica disease: morphological and
Department of Diabetes, Elias Hospital, histopathological aspects
Bucharest, Romania
Mihai Palaga, Adrian Dumitru, Tiberiu-
Objective: Hypoglycemia unawareness (HU), Augustin Georgescu, Diana Maria Bran
defined as the onset of neuroglycopenia before
the appearance of autonomic warning symptoms, University of Medicine and Pharmacy Carol
occurs in 40% of patients with type 1 diabetes Davila, Bucharest, Romania
mellitus (T1DM). Possible mechanisms include
chronic exposure to low blood glucose, anteced- Autosomal recessive polycystic kidney disease
ent hypoglycemia, recurrent severe hypoglyce- (ARPKD) is an important inherited cause of
mia, failure of counter-regulatory hormones. chronic kidney disease with an estimated inci-
Methods: We report the case of a 40-year-old dence of 1 in 20.000 live births. It results from a
female, diagnosed with T1DM at the age of 4 mutation in the pKHD1 gene located on chromo-
years old. She was admitted to our department some 6p. This results in bilateral symmetric mi-
with high glucose variations (26 to 389 mg/dl) and crocysts disease occurring in the distal convoluted
severe hypoglycemic crisis with loss of conscious- tubules and collecting ducts. This entity usually
ness. She was on basal-bolus therapy, fast acting associates pulmonary hypoplasia resulting from
insulin, lispro (6IU-4IU-5IU) and long-acting insu- oligohydroamnios and hepatobiliary disease
lin, glargine 12IU. She had no diabetic complica- (40%-60% of infants have hepatobiliary abnor-
tions. From her medical history we note total thy- malities). Genetic testing can often support a di-
roidectomy for Graves disease in 2008, now on agnosis, although it is not routine and is usually
replacement therapy with levothyroxine 100 made when parents already had a child with AR-
mcg/day. During admission blood tests showed PKD.
HbA1c=7.5%, TSH=0.842 mIU/ml, normal lipid In the last year, we report two cases of fetuses
profile, renal and liver function. Several episodes with ARPKD at the Emergency University Hospi-
of asymptomatic hypoglycemia were confirmed, tal in Bucharest. In this study we will elaborate a
the patient having no autonomic symptoms at positive diagnosis for this rare entity based only
glucose levels of 26 mg/dl. She was still able to on the macroscopic and histological findings.
speak and give personal correct information de- In our study, we performed autopsies on both
spite the severe hypoglycemia. We decided to fetuses suspected of ARPKD. One fetus was
use an insulin pump therapy in order to get better aborted at 17 weeks and the second fetus was
glycemic control and the disappearance of severe born alive before term and died of multiple organ
hypoglycemic events. The quality of life of the pa- dysfunction. Gross examination of the kidneys
tient and her family improved. After three months was performed on both of the suspected cases of
the patient had better glycemic control, with no ARPKD. Both kidneys were symmetrically en-
hypoglycemic events and a decrease in insulin larged and had a uniform distribution of micro-
doses of more than 30%. cysts throughout the cortex and the medulla. Fur-
Conclusions: HU is a complex phenomenon thermore, we analyzed the histological aspects of
that carries with it great risk to patients. Our case the kidney and liver of both cases with ARPKD on
supports previous studies that have shown a re- hematoxylin and eosin stain. We note that a final
duction in HU and better glucose profile with in- diagnosis for ARPKD can not be put without a
liver biopsy.

ABSTRACTS
The histological results can put in most cases Conclusions: The study sucesfully measured
the positive diagnosis. Microscopically, we found total sleep time and quality of sleep, expressed as
characteristic aspects in both ARPKD cases at the a percentage of alternating REM and non-REM
kidney biopsy, such as elongated cysts that were cycles, as well as providing a solid stepping stone
radially arranged, the few remaining glomeruli for follow-up experimentation in the field.
that were not involved by the cysts and the de-
creased intervening parenchyma. Both cases with
ARPKD associated congenital hepatic fibrosis (30) Peri-interventional
with dilated embryological bile ducts and paren- complications in respiratory
chymatous organ dysplasia.
ARPKD is known as a rare disease, but in the
pathology
last years it had shown an increasing incidence. Andreea Lescaie, Cristina Osiac,
We presented a complete histolpathological ex-
amination which led us to a positive diagnosis of
Ana-Cristinel Popescu
ARPKD. University of Medicine and Pharmacy Carol
(28) The neurobiology of
Approximately 7000 new cases of respiratory
sleep: cause, catalyst and disease are recorded annually, most prevalent of
mirror for a diverse which being a cause of restrictive, obstructive or
mixed ventilatory dysfunctions. Investigations are
pathology frequently required, not only for treatment, but
Alin Teodosiu, Corina Burcea also for diagnostic purposes. Some of the most
performed invasive procedures that have associ-
University of Medicine and Pharmacy Carol ated complications are bronchoscopy, evacuatory
Davila, Bucharest, Romania or exploratory thoracentesis and arterial punc-
ture. In this study, our objectiv is to evaluate the
Objectives: Sleep as a neurobiological properi-interventional risk. We collected the data of
cess has been credited in literature for its underly- 55 patients hospitalized at Marius Nasta Insti-
ing complexity regarding integration of vital func- tute of Pulmonology, Bucharest. We analyzed the
tions in the human organism. The first part of the
frequency of intervention-associated complica-
presentation will focus on brief examples from
tions, the pathologies in relation to the complica-
various medical specialities in order to establish a
tions that appeared, the treatment administered
common ground with the audience. However,
for the management of resulting symptoms and
the main purpose of this study is to propose the
the evolution of the general state of the patient
usage of actigraphy as an alternative method of
under treatment. Peri-interventional complica-
measuring parameters during sleep, allowing for
higher patient compliancy and comfort while of- tions occurred in 76% of the cases. Arterial punc-
fering important clues to a more complete diag- ture was performed on 34.55% of the patients,
nosis. 68.42% of them presenting complications (most
Methods: The study uses instances of sleep frequently involving radioulnar hematoma). Bron-
gathered using an actigraphy software on an choscopy was carried out in 83.64% of the cases,
Android-powered device. The device was pla- 58.70% of which ending up with at least one
ced next to the subject before the onset of sleep complication, most commonly oxygen desatura-
and using the build-in accelerometer, the move- tion, recorded by pulse oximetry. Thoracenteses
ment throughtout the instance was measured and were performed in 16.36% of the cases, and
was equivalated to the respective sleep cycles (al- complications arose in 77.78% of them (primarily
ternating REM and non-REM). pain). Rare severe complications in patients with
Results: A total of 170 sessions of sleep were high morbidity were encountered. Isolated cases
gathered, with the most frequent duration of 8 to of complications might have been a result of
9 hours of sleep per instance (46 instances out of medical malpractice. The majority of peri-inter-
the total) and the most frequent efficency of 30% ventional complications were noted in patients
to 35% (40 instances out of the total). Efficency presenting associated comorbidities to their respi-
was compared to a less than 8 hour and more ratory disease. Proper treatment was promptly
then 8 hour sleep duration yeilding a weak asso- administrated, ensuring an improvement in pa-
ciation between efficency and higher number of tients state throughout hospitalization.
hours slept - Spearmans rho: 0.241; 95% Confi-
dence interval: [0.094...0.378].

ABSTRACTS
(31) Macrophage activation and FFP. Treatment was continued with oral pred-
nisolone (0.8 mg/kg) and cyclosporine A (2 mg/
syndrome in systemic lupus kg) daily. A favorable clinical and laboratory out-
erythematosus come was achieved.
Conclusions: SLE-associated MAS is a rare
Alice Andreea Musca, Anca Boca, entity. Due to its clinical and laboratory resem-
Ancuta Ioan blance with a SLE flare differential diagnosis might
Department of Internal Medicine and be challenging. An early expert consultation and
Rheumatology, National Institute for Research proper therapy are the key components of im-
I.Cantacuzino, Bucharest, Romania proving the patients outcome.
Background: Macrophage activation syn- (34) Acute kidney injury

drome (MAS) has scarcely been described in as- mortality-related risk
sociation with systemic lupus erythematosus
(SLE). Despite poorly understood, it is now recog- factors in an emergency
nized that this condition belongs to a group of clinical hospital one
diseases known as hemophagocytic lymphohis-
tiocytosis (HLH). Treatments of several cases of center experience
MAS have led to the observation that the use of Ileana Peride1, Ileana Vacaroiu2, Daniela
high dose corticosteroids associated with cyclo-
Radulescu1, Cristiana David2, Andrei
sporine A has proven its benefit in the manage-
ment of this disorder. Niculae1, Ionel Alexandru Checherita2
Objectives: The purpose of this case presen- 1
tation is to increase the awareness about this rare Davila, Bucharest, Romania
complication of several rheumatic diseases such 2
Clinic of Nephrology and Dialysis Sf. Ioan,
as: systemic onset juvenile arthritis, adult-onset Bucharest, Romania
Still disease and rheumatoid arthritis.
Methods: A brief case report of MAS which Objectives: AKI represent a frequent compli-
occurred as onset of SLE induced by sulfasala- cation in critical-ill patients, associated also with
zine. unfavorable short-term prognosis. Therefore, the
Results: We present the case of an 18 years aim of the current study was to assess all admitted
old woman who was admitted to hospital with a patients in our hospital and to determine the
4-week history of malaise, weight loss and leth- most common causes of AKI onset, associated co-
argy. Her medical past was remarkable for auto- morbidities and to evaluate the short-term prog-
immune thyroiditis and rheumatic syndrome nosis in AKI subjects.
treated with sulfasalazine (SSZ). Her family histo- Methods: A retrospective study was per-
ry was positive for discoid lupus erythematosus. formed that included all admitted patients in our
Her physical examination was inconclusive but emergency clinical hospital, between January and
her lab results showed pancytopenia, hypertri- December 2014 that were diagnosed with AKI,
glyceridemia, hyperferritinemia, hypofibrinogen- according to KDIGO diagnosis criteria (n = 97
emia, raised values of AST, ALT and GGT. Hepati- individuals).
tis B and C test came out negative. The immu- Results: In our trial, female gender was more
nological screening was positive for ANA, anti- affected, with a mean age of 69 7.6 years. 78%
dsDNA, anti-histone, anti-ribosomal P protein of patients (~ 75 cases) had no previous history of
and anti-nucleosome antibodies. Antibody pro- renal impairment, and 22% were known with dif-
files for the diagnosis of antiphospholipid syn- ferent stages of CKD. When assessing our data,
drome were present. Serum C3 complement fac- infection events represented the main cause of
tor and ESR were low, while the level of CRP was AKI, observed in 44% of cases from which 23%
elevated. The urinalysis revealed proteinuria with developed sepsis associating multiple organ dys-
RBCs, WBCs and hyaline casts. A mildly enlarged function syndrome. Other important AKI causes
spleen was found at abdominal ultrasound evalu- were: nephrotoxic administration (drugs 11%,
ation. After further evaluation the diagnosis of iodine contrast substances 9%), perioperatory
drug induced SLE (probably by SSZ) with MAS complications, cardiovascular disorders (massive
onset was established. The patient received pulse heart attack 6%, decompensated heart failure
therapy with methylprednisolone (1g/day), cyclo- 12%) and acute pancreatitis (5%). Most of our
phosphamide (500 mg/m2), platelet transfusions patients were diabetics (24%) and with different

ABSTRACTS
cardiovascular disorders (53%) hypertension the effects of heparin versus taurolidine-citrate-

and heart failure. In 21% of cases different types heparin as hemodialysis catheter lock solutions.
of neoplasia was identified uro-genital tumors Methods: Between January 2014 and April
represented the most common cause of AKI 2015, a 16 months observational study was per-
(13%), noticed especially in the female popula- formed that included all chronic HD patients di-
tion. Consequently, most of the AKI individuals rectly on long-life catheters (LLC) or central ve-
required renal replacement therapy 1-3 hemo- nous catheters (CVC), admitted in our hospital. In
dialysis (HD) sessions per week. Furthermore, it the first 8 months, 5000 IU/mL heparin dose was
was noticed that 55% of them regained complete administrated as catheter lock solution, and in the
renal function, 6% remained in chronic HD pro- following 8 months, taurolidine-citrate-heparin
gram, and 39% deceased (especially from the pa- was used catheter lock content: 1.35% tauro-
tients that needed dialysis treatment). Another lidine, 4% citrate, 500 IU/mL heparin.
important feature was that AKI in known CKD Results: When comparing the 2 periods of
patients developed mostly in elderly subjects with administration, the use of taurolidine-citrate-hep-
a longer period of dialysis requirement, com- arin as catheter lock solution was more efficient
pared to de novo AKI noticed especially in young- as antimicrobial and antithrombotic agent com-
er patients. pared to heparin single use: 15 thrombosis events
versus 18 episodes, 20 bloodstream infections
Conclusions: Our study emphasized that in-
(75% Gram-positive, 25% Gram-negative) versus
fection episodes represented the most cause of
41 events (63% Gram-positive, 37% Gram-nega-
AKI development, and that short-term prognosis
tive) p <0.001. Additionally, in the first period
(including also the number of HD sessions) was
of our study, 198 catheters (CVC and LLC) were
influenced by etiology, preexistent renal failure
used versus 188 in the following 8 months that
and associated comorbidities.
highlights a better CVC/LLC permeability when
4% citrate locks are used.
(35) Taurolidine-citrate- Conclusions: Our findings emphasized the
heparin versus heparin beneficial effects of taurolidine (1.35%)-citrate
(4%)-heparin (500 IU/mL) as catheter lock solu-
efficient hemodialysis tion in increasing catheter permeability and de-
catheter lock solution for creasing thrombosis and infections events, espe-
cially the Gram-negative bacterial episodes, but
improving hemodialysed further long-term clinical trials are required for a
patients outcome better assessment of these data.
Andrei Niculae1, Cristiana David2,

Daniela Radulescu1, Ileana Vacaroiu2,
(38) Endovascular
Ileana Peride1 treatment in a case of acute
1
University of Medicine and Pharmacy Carol embolic mesenteric
Davila, Bucharest, Romania ischemia
2
Clinic of Nephrology and Dialysis Sf. Ioan,
Bucharest, Romania Lucian Predescu1, Lucian Zarma2,
Taisia Tiron1, Bogdan Radulescu2,
Objectives: Hemodialysis catheter-related Costin Scarlat3, Carmen Ginghina1,2
bacteremia and thrombosis represent frequent 1
Emergency Institute for Cardiovascular Diseases
causes of increased morbidity in hemodialysed
CC Iliescu, Bucharest, Romania
(HD) patients. According to European Renal Best 2
Practice, the use of antimicrobial catheter locks
represent a viable and efficient solution of blood- 3
Emergency Clinical Hospital Sf. Ioan, Bucharest,
stream infections prevention, especially the use Romania
of 4% citrate locks present decreased rates of
associated risks. Furthermore, there are data Objectives: Acute mesenteric ischemia is as-
highlighting the antithrombotic effect of 4% ci- sociated with a very high mortality rate if it is not
trate locks, but failed to prove a better catheter rapidly diagnosed and treated. Treatment of arte-
permeability when comparing to common hepa- rial occlusive acute mesenteric ischemia has his-
rin dose administration (5000 IU/mL). Therefore, torically involved primary surgical exploration,
the aim of our study is to underline and compare revascularization, and resection of infarcted bow-

ABSTRACTS
el. However, recent reports suggest that endovas- MRI current findings used for the correct staging
cular revascularization is associated with very of patients with multiple myeloma.
high procedural success, relatively favorable out- Methods: Patients with MM are explored in
comes as compared with a more traditional open our department by MRI in the purpose to evalu-
approach. ate bone lesions, complications and to follow up
Methods: We present the case of a 66 years the disease under treatment. In all patients, MRI
old male patient with poorly anticoagulated atrial evaluation correspond to a standardize protocol:
fibrillation admitted for left lower leg pain for two spin-echo (T1-weighted and T2-weighted), STIR,
days and abdominal pain for 4 hours. An abdom- diffusion weighted (DW) and contrast material-
inal and pelvic computer tomography scan was enhanced spin-echo (with and without fat sup-
made, that showed occlusion of the superior pression) sequences.
mesenteric artery without sign of bowel ischemia Results: In most of the cases, the patterns of
and occlusion of the left external iliac artery. The bone marrow infiltration at MRI can have a dif-
superior mesenteric artery was revascularized us- fuse or focal appearance, showing low signal in-
ing a complex endovascular stenting technique tensity on T1-weighted images, high signal inten-
and the external iliac artery was revascularized sity on T2-weighted/STIR images and generally
using fogarty catheter by a mixed interventional- showing enhancement on gadolinium contrast-
surgical team. After an initial good clinical course, enhanced images. MRI evaluation allowed de-
the patient developed systemic inflammatory re- tecting and characterizing different infiltration
sponse syndrome and multiple organ dysfunction patterns: focal involvement, homogeneous dif-
syndrome with exitus. fuse infiltration, combined diffuse and focal infil-
Results: After the revascularization of mesen- tration and salt and pepper pattern with inho-
teric arteries we should take into account the risk mogeneous bone marrow signals due to multiple
of reperfusion injury with systemic inflammatory fat islands.
response syndrome and worse clinical outcomes. MRI has a high prognostic significance. The
Conclusions: Acute mesenteric ischemia is a presence of more than seven focal lesions with a
life threatening disease that can be managed by diameter of more than 5 mm was correlated with
surgery or endovascular therapy. The endovascu- a poorer prognosis and the presence of normal
lar therapy showed great efficacy and good clini- bone marrow in patients with stage III disease of
cal outcomes even in technically demanding in- the Durie and Salmon staging system has been
terventions, and it becomes an alternative to associated with a significant increase in survival
surgery. Prevention and treatment of the reperfu- rate.
sion syndrome is essential for a good clinical evo- Conclusions: MR provides accurate informa-
lution after mesenteric revascularization. tion regarding the specific pattern of marrow in-
volvement, helps to detect asymptomatic lesions,
(43)The clinical utility of the sites of focal disease for safe bone biopsy, its
complications and the results under treatment.
MR imaging in diagnosis
and follow-up of myeloma (46) Aggravation of a renal
multiple: old and new congenital malformation
approaches case presentation
Mihaela Buzoianu1, Ioana Gabriela Ioana Andreea Ghita1, Patricia Monalisa
Lupescu1, Emi Marinela Preda2 Paraschiva1, Dorin Dragos2
1
Department of Radiology and Medical 1
Imagistics, Fundeni Clinical Institute, Bucharest, Davila, Bucharest, Romania
Romania 2
Emergency University Hospital Bucharest,
2
University of Medicine and Pharmacy Carol Romania
Objectives: Renal congenital malformations
Objectives: In multiple myeloma (MM), the involving reduction of renal tissue lead to glomer-
most common primary malignant bone disease, ular hypertension and hyperfiltration, which, in
may result in osteolytic lesions, bone fractures, turn, may lead to glomerular sclerosis. In these
and osteoporosis, with attendant morbidity and cases, early diagnosis of the malformation and
mortality. We aimed to review and illustrate the continuous monitoring are essential in order to

ABSTRACTS
prevent renal failure and to avoid any additional (47) Multiple cutaneous
risk factors that may aggravate the condition.
Methods: A 21-year-old male patient, diag- leiomyomas an atypical
nosed with unilateral renal agenesis at the age of case of a 72 years old
11, is admitted to the Nephrology Department of
Bucharest University and Emergency Hospital
woman
with peripheral and palpebral edema. His mother S.R. Georgescu1, I. Ceban, E. Musa2,
was diagnosed with systemic lupus erythemato- I. Sarbu, V. Benea2, M. Tampa1,
sus (SLE) at the age of 33. Upon admission, phys-
ical examination reveals normal blood pressure.
I.G. Motofei2, A.M. Limbau2
1
Further investigations reveal nephrotic-range pro- University of Medicine and Pharmacy Carol
teinuria (12g/24h), hypercholesterolemia, hyper- Davila, Bucharest, Romania
2
triglyceridemia, hyperfibrinogenemia, high he- Department of Dermatology, Hospital Victor
matocrit and high erythrocyte sedimentation rate. Babes, Bucharest, Romania
Immunologic tests are positive for anti-SS-A, anti-
Ro-52 and anti-SS-B antibodies, which are highly Objectives: A leiomyoma is an uncommon,
indicative of genetically inherited SLE. The pa- benign tumour of smooth muscle. Although the
tients severe proteinuria and normal urinary cel- skin is the second commonest location for leio-
lularity together with SLE point to lupus glomeru- myoma after uterus, it accounts only 5% of cases.
lonephritis (probably class V membranous lupus Regarding the etiopathogenesis, it remains un-
glomerulonephritis). Renal biopsy is needed to known.
confirm this diagnosis, but the patient refuses the The treatment is dictated by the number of
procedure. Specific treatment for the autoim- lesions and the degree of discomfort.
mune glomerulopathy consisting of methylpred- Methods:We report the case of a 72 years-old
nisolone and cyclophosphamide is proposed. Hy- female patient who addresses our clinic com-
pocholesterolemic and anticoagulant treatment is plaining of multiple raised skin lesions on the face
initiated. and neck. The lesions had been gradually increas-
Conclusions: The particularity of this case ing in number over the last 20 years. Over the last
consists of the association of a congenital renal five years, the patient had started observe inter-
malformation with an autoimmune disorder. Fur- mittent pain over the lesions, especially on expo-
thermore, solitary kidney is considered a relative sure to cold, pressure, or emotional stimuli. The
contraindication to renal biopsy and cyclophos- local examination revealed numerous well cir-
phamide is known to induce sterility, which is cumscribed red to brown, skin colored papules
particularly troublesome in a young childless indi- and nodules, over the forehead, cheeks and ex-
vidual. The difficulty in establishing the exact type tensive lesions over the neck.
of glomerular lesion and the adverse effects of the Clinical diagnosis of cutaneous leiomyomas
treatment add to the complexity of this case, es- was confirmed by multiple skin biopsies over the
pecially from an ethical point of view. The pa- last years. The patient received treatment with
tients decision whether or not to start immuno- calcium channel blockers (nifedipine) without sig-
suppressing treatment is awaited. nificant amelioration.
Results: Due to the large number of lesions
and the anatomic location, the total surgical exci-
sion could not be performed. The patient contin-
ues the treatment with nifedipine and we made
several sessions of cryotherapy, without any im-
provement. Gabapentin was another option.The
basic aim was to do something for relieving the
patients pain..
Conclusions: This case presents several im-
portant particularities. Firstly, cutaneous leiomyo-
mas represent a very rare pathology, especially in
the elderly, generally occuring in the age group of
10-30 years. Secondly, the anatomical area where
lesions have developed is unspecific. The most
common sites of involvement remain the extrem-
ities and the trunk.

ABSTRACTS
In our case, the patient was not affected by fort. Peter Stark put it that way: Emotional intel-
the aesthetic component and all the treatments ligence is when you finally realize its not all about
for pain relief were useless. you!
(50) Emotional intelligence (54) A rare association of

and proactive role in HD synchronous chronic
therapy lymphocytic leukemia and
Dumitra Mariana Marita essential thrombocytemia
University of Medicine and Pharmacy Carol with different clonal origins
Davila, Bucharest, Romania Nicoleta-Monica Fotea, Nicoleta
Emotional intelligence (EI) is defined as the
Mariana Berbec, Radu Mihai Dragulin
ability to identify, express and control emotions University of Medicine and Pharmacy Carol
comprising self-awareness and social awareness. Davila, Bucharest, Romania
EI it is important for success and satisfaction at
work and influences a persons attitude towards Objective: The first study that investigated the
work, his/her ability to effectively work as a team association of simultaneous chronic lymphocytic
effectively, and manage stress. leukemia (CLL) with myeloproliferative neo-
Our unit focusses on high-quality training and plasms (polycythemia vera, essential thrombocy-
personal development of the medical staff to en- temia-ET, primary myelofibrosis or chronic my-
sure that the therapeutic roles in dialysis are per- eloid leukemia) was done in the GIMEMA cohort.
formed with empathy and compassion. Until april 2016 there are described only 8 cases
Objectives: Developing emotional intelli- with synchronic CLL and ET. In this case-report
gence skills, to measure nurses EI and assess it in we present the coexistence of CLL and ET with
association with their work abilities. distinct clonal origins and associated comorbidi-
Methods: Relationship Management influ- ties.
ences, inspires and creates a strong bond be- Methods: A 67-year-old man was admitted to
tween employees and employers via effective Coltea Hospital for a routine control. The clinical
communication. Therefore, in order to improve examination was unremarkable, but the hemo-
our EI, we must cultivate effective communica- gram showed Hb=14.1g/dL (normal values 13.5-
tion skills. 17.5g/dL), leucocytes=10.290/mm3 (4500-
Data were collected by means of the Emo- 11.000), lymphocytes=5453/mm3 (600-3500/
tional Intelligence tests (Bar-On and Goleman) mm3), platelets=800.000/mm3 (150.000-
and personality questionnaires. 400.000/mm3); the remainder of the paraclinical
50 nurses with more than 5 years of work ex- data was within normal limits. The peripheral
perience completed the questionnaires. blood smear showed 53% small lymphocytes,
Results: Evaluation of the questionnaire normal erythrocytes and large groups of thrombo-
showed that 80% of nurses had an average score cytes. Contrast enhanced CT of the chest and ab-
of 125-175 points and 20% an average score of domen revealed small, laterocervical adenopa-
100-125 points. Nurses were aware of the impor- thies. No hepatosplenomegaly was noted. The
tance of EI and matched the following personality diagnostic procedures were an immunopheno-
types: Phlegmatic, choleric, and passionate tem- typing of peripheral blood and bone marrow as-
perament. There was a strong correlation be- piration and an osteomedullary biopsy.
tween the EI score and the ability of stress man- Results: The immunophenotyping showed
agement, self-evaluation of a good performance 59% lymphocytes B, CD19+, CD3+, CD5+,
in communication and with job satisfaction. CD23+, FMC7-, CD79a+, k+/-, CyIgM+,
Conclusions: All studied nurses were aware CD20+, CD38+, CD43+, CD11c +/-, CD65
of the importance of EI. They achieved an aver- and CD35 low positive, myeloperoxidase low
age of 100 or more points for EI, with 80% scor- positive, which sustains the diagnosis of CLL with
ing between 125 and 175 points. A high EI seems atypical presentation due to the coexistence of
to be associated with stress management ability, both type of markers: myeloid and lymphoid.
perceived communication performance, and job The osteomedullary biopsy unveiled atypic hy-
satisfaction. Emotional intelligence is a skill that perplasia of the megakaryocytic lineage, a slight
anyone can improve with a little patience and ef- increase of reticulin fibers and left deviation of

ABSTRACTS
granulocytopoiesis, consistent with ET. FISH for diagnosed with ED not otherwise specified (NOS)
t(9:22) was negative as well as the BCR-ABL tran- (31%), followed by Bulimia Nervosa (BN) (25.7%),
script, but with JAK2V617F positive and normal Anorexia Nervosa (AN) (21.2%) and Binge Eating
caryotype. The final diagnosis was: CLL RAI 0-1, Disorder (BED) (17.7%).
intermediate risk (ZAP70-, CD38+, IgVH mutat- Results: Among patients with AN, higher
ed), Chronic Myelodysplastic Syndrome-Essential scores in BDI are associated with a statistically sig-
Thrombocythemia-meeting OMS criteria, high nificant increase of State-Anger (p=0.008), Trait-
risk (age >60, cardiovascular risk factors). In ac- Anger (p=0.035), Anger Control-Out (p=0.026)
cordance with international therapeutic guide- and Anger Expression Index (p=0.008). Among
lines, the pacient was managed with a watch subjects with BED, a severe state of depression is
and wait approach for the CLL and with hy- often associated with Trait-Anger (p=0.002), An-
droxyurea and aspirin for ET. In evolution, two ger Expression-Out (p=0.003) and Anger Expres-
years after diagnosis, the pacient developed my- sion Index (p=0.057). Similar observations were
eloid metaplasia with myelofibrosis grade I sec- made among subjects with ED NOS, where high
ondary to ET. scores of State-Anger (p=0.040), Anger Control-
Conclusion: We describe the case of one pa- Out (p=0.011) and Anger Expression Index
tient with concurrent two different hemoprolifer- (p=0.013) are found in depressed patients.
ations, CLL and ET, and furthermore we prove by Conclusion: Depressive patients diagnosed
FISH, immunophenotyping and molecular analy- with AN, BED or ED NOS experience more prob-
sis the independent origin of the two diseases in lems regarding anger control, anger expression
unrelated clones. and express higher levels of aggressiveness com-
pared to ED patients without depressive symp-
(57) Eating disorders: is toms. Moreover, patients with depressive symp-
toms associate different modalities of expressing
depression leading to anger, correlated with the type of ED they are di-
aggression? agnosed with. These findings draw attention to
the importance of evaluating patients with EDs
Cristiana Tapoi1, Anna-Rita Atti2 for depression, as well as for aggressiveness, in or-
1
University of Medicine and Pharmacy Carol der to provide the proper therapeutic approach.
2
Alma Mater Studiorum University of Bologna, (60) The predictive value of
Italy
NT PRO BNP in patients
Objective: Feelings of anger, hostility and ag- with intermediary-high risk
gression are frequently co-occurring in patients pulmonary embolism
with Eating Disorders (EDs), and this correlation
augments when affective disorders are involved. Alexandru Ion1, Dragos Craciunica2,
We aimed to explore how depressive symptoms Mihaela Raileanu1, Andreea Lacraru2,
alter both perception and expression of anger in
Catalina Andrei1, Crina Sinescu1
every type of EDs, in order to improve the under-
1
standing of the association between various man- University of Medicine and Pharmacy Carol
ifestations of anger and clinical presentation. Davila, Bucharest, Romania
2
Methods: We assessed 113 ED patients ad- Emergency Hospital Bagdasar Arseni, Bucharest,
mitted to Institute of Psychiatry P. Ottonello Romania
University of BolognaEating Disorders Unit with
the following psychometric tests: Beck Depres- Objectives: The main objective of the present
sion Inventory (BDI), a self-report questionnaire study is to assess a correlation between the Nt pro
that evaluates the severity of depression, and BNP value on admission, as a marker of RV dys-
State-Trait Anger Expression Inventory 2 (STAXI-2), function, and early mortality in patients with in-
a tool that distinguishes between various compo- termediary-high risk PE. As a secondary objective
nents of anger by defining intensity of anger we assessed the effect of thrombolytic therapy
(State-Anger), disposition to experience angry t-PA- on NT pro BNP values (value on admission
feelings (Trait-Anger), anger expression (Anger vs value on 7 day) compared to the effect of un-
Expression-Out), anger control (Anger Control- fractionated heparin.
Out) and provides an overall measure of anger Methods: We selected 75 pts with intermedi-
expression (Anger Expression Index). According ary high risk PE. The Nt pro BNP value was deter-
to the EDs classification, most of the patients were mined in all patients on admission and on 7 days.

ABSTRACTS
The patients were divided: study group was treat- niscus were compared. One of them consisted in
ed with t-PA (10mg bolus and 90mg in 90 min) supervised medical exercise therapy versus unsu-
and unfractionated heparin while the control pervised treatment.
group was treated with unfractionated heparin Method: A prospective randomized con-
alone (aPTT guided). Patients older than 75 y.o, trolled trial with 6 months and one year follow-up
severe renal failure (Creatinine clearance <30 was conceived. Over 3 months, 67 participants
ml/min), anemic syndromes and contraindica- were randomly assigned into either a supervised
tions for thrombolytic therapy were included in medical exercise therapy group (n = 35) or in a
the control group. control group/unsupervised therapy (n = 32).
Results: The mortality rate in the study group Pain was evaluated by score of a visual analogue
was 7.14% while in the control group 21.6% (p scale (VAS) and function was asses by functional
0.09), statistically insignificant but the difference tests and recorded within functional assessment
between the two groups was very important. Us- questionnaire.
ing ROC curves and t test with unequal variances Results: Prognostic variables were almost sim-
the Nt pro BNP was determined as a strong pre- ilar between the groups at baseline, with (6 %)
dictor for early mortality in the study group (AOC patients dropping out during the first 6 months of
0.884), with a cut-off value of 8420pg/ml, while the treatment and (9 %) before the one-year fol-
in the control group it was not correlated wih the low-up. After 6 months, the supervised medical
mortality rate (AOC 0.48). Meanwhile the Nt pro exercise therapy group achieved significantly bet-
BNP on 7 days was reduced by 66.28% in the ter outcome effects than the control group in re-
study group vs 28.44% in the control group com- spect to pain and function. The results after the
pared to admission Nt pro BNP (p-0.02) one year follow-up indicated the same trend.
Conclusions: The predictive value of Nt pro Conclusion: Postoperative supervised medi-
BNP in patients with intermediary risk PE is pres- cal exercise therapy lead to a significant function-
ent for patients with thrombolytic therapy and al improvement in patients after arthroscopic sur-
the effect of this therapy compared to anticoagu- gery for degenerative meniscus of the knee
lants on mortality and Nt pro BNP value is very according to visual analogue scale and functional
important and should be studied further. tests assessment.
(66) Does postoperative (69) Early subclinical

supervised medical exercise cardiac dysfunction in
therapy lead to a significant gestational hypertension
functional improvement in and preeclampsia
patients after arthroscopic Natalia Patrascu1, Diana Janina
surgery of degenerative Mihalcea1, Sorina Mihaila1, Laura
meniscus of the knee? Lungeanu Juravle2, Livia Florentina
A randomized controlled Trasca2, Manuela Neagu1, Simona
trial with 6 months and one Elena Albu1, Bogdan Luchian1,
Monica Cirstoiu1, Dragos Vinereanu1
year follow-up
1
Georgiana Ozana Tache Davila, Bucharest, Romania
2
University of Medicine and Pharmacy Carol Emergency University Hospital, Bucharest,
Aim: Since there is no consensus on a postop- Background: Gestational hypertension (GHT)

erative rehabilitation program for patients who and preeclampsia (PE) are the most frequent
have undergone arthroscopic surgery for medial medical complications in pregnancy. Direct ef-
meniscus damage, the aim of this trial was to fects of these conditions on cardiac function are
evaluate if there is any significant functional im- insufficiently studied.
provement when patients adhere to such a pro- Objectives: To evaluate subclinical changes in
gram. In this respect, the functional status follow- cardiac function in pregnant women diagnosed
ing two rehabilitation approaches after arthro- with GHT or PE compared to a normal group
scopic surgery in patients with degenerative me- matched for age and pregnancy duration.

ABSTRACTS
Methods: We studied 28 pregnant women (76) Management of

with GHT or PE, no other cardiac or medical dis-
eases and 22 normotensive pregnant women as dysphagia at the elderly
control. Systolic left ventricle (LV) global function patient case presentation
was assessed by 4D LV ejection fraction and lon-
gitudinal systolic function by TDI S wave. For dia- C. Badiu1, V.T. Grigorean2, C.D. Gita2,
stolic LV global function we used multiple spectral A. Zamfirescu1, R. Dascalescu1,
and tissue Doppler parameters. Left atrial (LA) C. Tabara2, R. Mateescu2, S.M. Aurelian1,
function was assessed by volumetric measure- A. Capisizu1
ment of total, passive and active emptying frac-
1
tions (LAEF). University of Medicine and Pharmacy Carol
Results:There were no significant differences Davila, Bucharest, Romania
2
between GHT/PE and normal groups regarding Surgery Clinic, Emergency Clinical Hospital
mean age (32.16.1 vs. 32.33.9 years), preg- Bagdasar-Arseni, Bucharest, Romania
nancy weeks, primi-/multiparity or heart rate
(90.312.1 vs 83.911.2 bpm). Mean BP in Objectives: Dysphagia represents one of the
GHT/PE group was 161.1425.1/104.431.7 important symptomes in geriatric population. The
mmHg while in normotensives was 107.911.2/ management of those patients requires a multi-
65.99.8 mmHg (p=0.0001 for both systolic modal approach because of multiethiological
and diastolic BP). In hypertensive group, decrease causes of this swallowing disorder.
in 4D LVEF significantly correlated with increased Methods: A 69 year old male patient with a
actual weight (R= - 0.500, p=0.02), increased known history of hypertension, ischemic stroke
pre-pregnancy weight (R=-0.460, p=0.03) and and osteoarthritis is admitted to our clinic with
BSA (R=-0.410, p=0.02). Comparison between diffuse joint pains, dry cough, pain in the upper
GHT/PE and normotensive groups showed signifi- abdomen and a recently installed selective dys-
cant correlation of GHT/PE with pre-pregnancy phagia (esogastric). Clinical examination: con-
body mass index (30.14.9 vs 25.52.9 kg/m2, scious, well oriented, anxious, pallor of skin, loss
p=0.004). Both systolic global and longitudinal of appetite, BP=150/80 mmHg, pulse=80/min,
function were significantly decreased in GHT/PE BMI=19.26 kg/m2(weight loss ~7 kg/month),
group: LVEF (535.9 % vs. 58.76.4%, p=0.008) pain in the upper abdomen, no signs of perito-
and TDI S wave respectively (10.12.7 vs. neal irritation.
12.92.1 cm/s, p=0.001). Global diastolic LV Results: Upper endoscopy: Esophagus-stenos
parameters (E/A, TDE, e/a, E/e, Vp) did not dif- circumferential formation 25 cm from the top
fer between groups while isovolumic relaxation that didnt allow the endoscope to pass. Thoracic
time was prolonged in GHT/PE (86.714.7 vs. and abdomen CT(+intravenous contrast agent)
74.615.8 ms, p=0.02). Active LAEF did not dif- highlights: Nodular image in the upper segment
fer, while total and passive LAEF were significantly of LID, well-defined, diameter=8/7 mm, central
lower in GHT/PE group (67.88.2% vs calcificationpossibly a sequel nodule; Images of
73.56.8%, p=0.02 and 39.811.3% vs. lymph nodes situated paraaortic, in the Barety
50.28.8%, p=0.003 respectively). lodge and parathracheal, diameter=21 mm.The
Conclusions: Subclinical early cardiac systolic lower esophagus shows a circumferential parietal
and diastolic dysfunction was recorded in this thickness protrusion in the lumen, length=5.5
group of pregnancy-induced hypertension. cm, situated cranial from the cardia orifice, with a
Whether this condition is transitory or it main- thickness=23 mm, partially obstructing the lu-
tains after discharge, increasing risk to evolution men, with an irregular outline; the protrusive for-
to early heart failure in these patients should be mation also expands from the opening of the car-
established in further studies. dia orifice to the fornix. No intraperioneal free
fluids. Numerous images of precave and periaor-
tic lymph nodes, diameter=12 mm. Psychogeri-
atric consult: Mini Mental State Examina-
tion=25/30 points; Geriatric Depression Scale=
12/15 points. Primary diagnostic: Esogastric tu-
mor stenosis (indication for surgery and histo-
pathological analysis), Secondary diagnoses: hy-
pertension, depressive anxiety disorder
accompanied by cognitive impairment for which
we initiated antidepressants. Surgical procedure:

ABSTRACTS
superior esogastrectomy with end to end eso- Conclusions: Mushroom poisoning induces a
gastro-anastomosis by double approach, thoracic liver pro-oxidative status with progressive con-
and abdominal lymphadenectomy. Histopatho- sumption of antioxidant enzymes and a higher
logic result from esophageal mucosa fragment: vulnerability of liver cells. Supplementary therapy
tumoral proliferation of squamous cell carcino- with SOD might help improve the hepatocyte de-
ma. Postsurgical evolution was favorable, no fense mechanisms when faced to toxic injury.
complications and the fluoroscopic control
showed the integrity of the anastomosis. (81) Interdependence of
Conclusion: Dysphagia associated with unin-
tentional weight loss is a frequent health problem insulin sensibility and heart
increasing morbidity in elderly population. A failure in patient with
comprehensive geriatric assessment can detect
the causes of dysphagia which would be not only diabetes mellitus
gastrointestinal illnesses but also depression, de- Eleonora Dragan, Anamaria Avram,
mentia, diabetes mellitus, different types of can-
Crina Sinescu
cer.
Emergency Clinical Hospital Bagdasar- Arseni,
Bucharest, Romania
(79) Effects of superoxide
dismutase in mushroom Objectives: are to assess abnormalities of
poisoning case report myocardial metabolism in pacient with diabetes
mellitus and to correlate progression of heart fail-
Cristian Cobilinschi, Radu Tincu, Dana ure with impared insulin sensitivity.
Tomescu, Zoie Ghiorghiu, Radu Methods: We examined 52 pacients with car-
Alexandru Macovei diac insufficiency left ventricular systolic dys-
function and diabetes mellitus from Cardiology
Clinical Emergency Hospital, Bucharest, Romania Clinic of Bagdasar-Arseni Emergency Hospital,
from January 2015 until now. Patients have been
Objectives: Mushroom poisoning occurs fre- analyzed for heart failure by humoral measure-
quently by falsely identifying the species. Toxic ment (NTproBNP value) and echocardiographic
effects are carried through a variety of toxins that parameters. The assessment of insulin resistance
each mushroom type contains. Latest studies (HOMA-IR: homeostatic model assessment of in-
highlighted the presence of a correlation between suline resistance) index was calculated from fast-
alfa-amantine and lesions induced by oxygen re- ing glucose and insulin using the following equa-
active species. Superoxid dismutase (SOD) has a tion: (glucose [mg/dl] x insulin [IU/ml])/405.
protective role on the liver function. Logistic regression was used to examine charac-
Methods: We present the case of a 41 year teristics that were associated with insulin resis-
old female admitted in the Critical Care Toxicol- tance (HOMA-IR 2.5), adjusting for age, sex,
ogy Unit six hours after mushroom ingestion ex- body mass index, insulin dosage units (as continu-
hibiting gastro-intestinal manifestations. ous variable). In order to assess the relationship
Results: On admission she presented an al- between HOMA-IR values and heart failure stag-
tered state, abdominal pain, she was somnolent, ing, multiple Cox proportional hazards models
with visual hallucinations, hemodinamically and were fit in each case.
respiratory stable, present diuresis. Laboratory Results: Compared with control subjects, pa-
data revealed hepatic cytolysis, dyselectrolyte- tients with heart failure have similar glucose lev-
mia, cholestasis, hyperammonemia, altered co- els, but increased insulin levels, predictive for in-
agulation tests and an increase in the SOD level. sulin sensitivity. In multivariate analyses of
Volemic and electrolytic repletion was initiated, subjects, age, insulin and NTproBNP levels, left
gastric protection, antiemetics, digestive decon- ventricular ejection fraction and heart failure
tamination, vitamins and diuretics. We applied stage were independent predictors of impared in-
the protocol of antioxidant therapy with SOD sulin sensitivity.
capsules of 6000 units McCord/Fridovich. Patient Conclusions: Neurohumoral activation in
evolution was favorable with normalization of heart failure increase free faty acid metabolism
clinical and laboratory parameters at 72 hours af- and myocardial and systemic insulin resistance,
ter admission, including the SOD levels. ensuing detrimental myocardial energetic pertur-
bations. Understanding the aberrant metabolism
in general and cardiac energetics in particular, in

ABSTRACTS
diabetic pacient, may offer promising targets for re-classify any patients into having a LVEF more
heart failure therapy. than 35%, but reclassified almost 15% of the pa-
tients into having LVEF below 35% and therefore,
indication for device implantation.
(84) Is 3D interchangeable Conclusions: There was substantial agree-
with 2D echocardiography ment between 2D and 3D echocardiography
in establishing the measurements of LV ejection fraction in patients
with heart failure with reduced ejection fraction,
indication for regardless of the level of training in echocardiog-
resynchronization therapy raphy. However, more than 10% of the patients
were reclassified into having indication for device
in patients with heart therapy when using 3D instead of 2D echocar-
failure with reduced diography. Further studies should assess the need
for new cutoffs when using 3D echocardiography
ejection fraction? evaluation of the LV ejection fraction in patients
Sorina Mihaila1, Andreea Velcea2, with heart failure with reduced ejection fraction.
Anca Andronic2, Simona Ionela Calin2,
Lavinia Matei2, Denisa Muraru3, (85) Pseudomonas
Luigi Paolo Badano3, Dragos Vinereanu1 Aeruginosa infection, a clue
1
University of Medicine and Pharmacy Carol for Brutons disease?
2
Emergency University Hospital, Bucharest, Gabriela Chiritoiu, Alexis Virgil Cochino,
Romania Sigrid Covaci
3
University of Padova, Italy University of Medicine and Pharmacy Carol
Objective: To determine if three-dimensional
echocardiography (3DE) is interchangeable with Objective: To present a case of pediatric he-
two-dimensional echocardiography (2DE) in es- reditary agammaglobulinaemia and mention the
tablishing the indication for resynchronization difficulties in diagnosis, complications, treatment,
therapy in patients with heart failure with re- prognosis, and evolution.
duced ejection fraction (HFrEF), when used by Methods: A two year and two month old
trainees with different levels of expertise in 2DE male child was hospitalized in the Pediatric Emer-
and 3DE. gency Department of Constanta, Romania, for
Methods: Fifty-one patients with symptomat- erythematous maculopapular rash on the upper
ic HFrEF and regular cardiac rhythm (46 males, and lower limbs, oedema and necrosis of nasal
5817 years) underwent standard transthoracic wings, rhinorrhea, and fever. Physical examina-
2DE acquisitions and 3DE full-volumes of the left tion revealed one erythematous lesion on the
ventricle (LV), using Vingmed E9 (GE Ultrasound, right thigh with a necrotic center and a necrotic
Horten, Norway). lesion in the palatine raphe. The patients medi-
One expert observer with more than 2 years cal history was significant for recurrent episodes
of training in both 2DE and 3DE (Expert) and 3 of upper respiratory tract infections (8 per year)
trainees with different levels of expertise in 2DE and persistent high fever of unknown origin that
(Beginner, Medium and Advanced), after one lasted more than 8 but less than 11 days at a time.
month-training in 3DE, measured the 2D and 3D Nasal cultures were obtained which revealed the
LV volumes and ejection fraction (EF) on the same presence of Pseudomonas Aeruginosa. Due to
consecutive images, using Echopac BT 12 (GE Ul- the extent of the lesions, the patient was trans-
trasound, Horten, Norway). ferred to the Grigore Alexandrescu Emergency
Results: Average FPS of the 2DE images was Childrens Hospital in Bucharest with a suspected
708, and average VPS of the full-volumes was diagnosis of Steven Johnsons syndrome and un-
347. Mean LVEF was 3510% by 2DE, and known immunodeficiency. The lesions progressed
3310% by 3DE. and the patient had an episode of Ectyma Gan-
There was a substantial agreement between grenosum. The patient was subsequently trans-
2DE and 3DE classification of the LVEF (below ferred to Alessandrescu-Rusescu Institute for
and above 35%) for all the levels of training in Mother and Child Health for further investigation
2DE and 3DE (all kappa >0.60, but below 0.80). and specialized treatment. Upon performing flow
However, using 3DE, the expert observer did not cytometry, analyzing bloodwork results, and con-

ABSTRACTS
ducting further diagnostic tests suspicion was Our case illustrates the natural evolution of
raised for a diagnosis of X-linked hereditary agam- apical hypertrophic cardiomyopathy with MVO
maglobulinaemia (Brutons Disease). Genetic and apical aneurysm development during follow-
testing was performed and the results are cur- up 7 years after the initial diagnosis.
rently pending. The patient was started on intra- In one study the presence of MVO was identi-
venous immunoglobulins, 10 g/kg of bodyweight/ fied as an independent determinant of unfavor-
month, and prolonged antibiotics for the Pseudo- able outcomes. Moreover, apical aneurysm for-
monas Aeruginosa infection. It was concluded mation in patients with MVO strongly predicted
that the patient did not have Stevens Johnsons HCM-related adverse events. The main problems
syndrome but that the maculopapular rash and are the arrhythmogenic substrate and the risk of
necrosis was due to the Pseudomonas Aeruginosa fatal and nonfatal thromboembolic events.
infection in an immunodeficient child. The pa-
tient returned once per month for follow up. (88) Zika virus disease
Upon 4 months follow up, the patient reports no
recurrent infections or associated disability. outbreak in the Americas,
Conclusion: Due to the rarity of Brutons Dis- 2015 is Romania at risk?
ease (1 in 100,000 males) as well as its unspecific
clinical presentation, the suspicion for this diag- Teodora Ionescu1, Maria Dorina
nosis is rarely made. It is important to include this Craciun2, Daniela Pitigoi2
disease in the differential diagnosis in a pediatric 1
National Institute of Endocrinology C. I. Parhon,
male patient with recurrent infections and other
Bucharest, Romania
immunodeficiency-related symptoms. 2
(86) Apical hypertrophic
cardiomyopathy: from Objectives: On the 1st of February 2016, the
World Health Organization declared that the
midventricular obstruction clusters of microcephaly cases and neurological
to apical aneurysm disorders in areas affected by Zika virus (ZIKV)
constitute a Public Health Emergency of Interna-
Anamaria-Georgiana Avram tional Concern (PHEIC). ZIKV disease is caused
University of Medicine and Pharmacy Carol by an RNA virus transmitted to humans by Aedes
Davila, Bucharest, Romania mosquitoes, mainly Aedes aegypti and potentially
Aedes albopictus. There is no specific treatment
Apical hypertrophic cardiomyopathy is rarely or vaccine currently available.
confined only to the left ventricular apex. Mid-left Our aim is to evaluate the risk of ZIKV intro-
ventricular hypertrophy is responsible for the duction and transmission in Romania.
unique pathophysiology of this condition in Methods: We reviewed the medical literature
which the impedance to flow occurs at the mid- on the epidemiology of ZIKV, as well as relevant
cavitary level. Development of an apical aneu- risk assessments and guidelines. Available statis-
rysm from midventricular obstruction (MVO) may tics on the number of Romanian travellers to af-
be observed during follow-up period or may be fected countries were also examined.
observed at the initial evaluation. Results: As of April 6th 2016, Zika virus trans-
We report the case of a 67 years old male pa- mission was documented in a total of 62 coun-
tient presenting with exertional dyspnea and per- tries and territories. To date no autochthonous
sistent dry cough for four months. Medical history ZIKV transmission has been reported in the conti-
revealed apical hypertrophic cardiomyopathy di- nental EU, but 17 EU/EEA countries recorded at
agnosed 7 years back. Current echocardiographic least 359 imported cases.
evaluation revealed midventricular and apical hy- The Romanian population is thought to be im-
pertrophy, midventricular obstruction with a peak munologically nave. In Bucharest, entomological
instantaneous gradient of 50 mmHg and an api- investigations have revealed local established
cal aneurysm. Coronary artery disease was ex- populations of A. albopictus since 2012. In urban
cluded as a cause of apical aneurysm formation. areas, viraemic individuals appear to serve as the
Left ventriculography confirmed the presence of primary vertebrate host. The risk of transmission
the apical aneurysm. The patient has beed re- through sexual contact or substances of human
ferred for surgical evaluation for mid-left ventric- origin is hard to estimate for our country due to
ular resection. the low number of cases reported internationally.

ABSTRACTS
Mass gatherings can increase the transmission different from the initial rash, she was referred to
of the virus; however, Rio de Janeiro Olympics our clinic.
will be held during Brazils winter when the risk Results: The biopsy of the persistent papules
of infection is low. Of all outbound Romanian from the chest showed: acanthosis, local para-
tourists in 2013, at least 2548 (0.004%) visited keratosis, dyskeratosis confined to the upper lay-
Central and South America. ers of the epidermis as well as a sparse superficial
Conclusions: The risk of autochthonous dermal infiltrate containing scattered neutrophils
transmission of ZIKV has been considered ex- and rare eosinophils. There was no significant
tremely low during winter, although transmission dermal mucin deposition. Direct immunofluo-
is possible during summer if viraemic travellers rence microscopic studies were negative. The pa-
return to Romania. The relatively low compe- tient was treated with 60 mg daily dose of Predni-
tence of A. albopictus as a vector for ZIKV may sone and 15 mg weekly dose of Methotrexate
indicate that a high density of human-biting mos- and her systemic symptoms eventually resolved
quitoes and a large number of infected persons approximately 1.5 months after onset. The persis-
would be expected for an outbreak to occur. tent skin lesions faded within 10 days and did not
Early detection, vector control measures and recur during subsequent slow tapering of the ste-
public awareness are essential for the prevention roid treatment.
of ZIKV outbreaks. Conclusions: Stills disease is generally con-
sidered a disorder of youth, but there are several
(98) Adult-onset Still reports of new cases of AOSD in older people.
The diagnosis of AOSD can be made in the ab-
disease with atypical sence of the typical Stills rash but in the presence
cutaneuos features of other atypical cutaneous features. This case
confirms the characteristic clinical and histopath-
Mihaela Tovaru1, Delia ologic findings of persistent papules and plaques
Botezatu2, Simona-Roxana Georgescu1 of Stills disease and show the potential for this
1
eruption in the adult age groups.
2
National Institute of Pathology Victor Babes, (101) The use of balneo and
Bucharest, Romania physical therapy in
Objectives: Adult-onset Stills disease (AOSD) neurogenic bladder
is a rare idiopathic inflammatory disorder with Dan Nicolae Neagoe2, Consuela Monica
varied clinical manifestations.
Its diagnosis is one of exclusion and often dif-
Brailescu1, Anatoli Eugen
ficult and delayed. The four cardinal features of Covaleov2, Mihaela Silvia Marinica1
the disorder include polyarthritis/polyarthralgia, 1
Department Physical Medicine and Balneology,
high spiking fevers, leukocytosis with neutrophil- Clinical Hospital of Rehabilitation, Eforie Nord,
ia, and evanescent skin rash. Skin manifestations Romania
are often a critical component of disease recogni- 2
tion. Davila, Bucharest, Romania
Methods: We present the case of a 63 years
old female patient who had initially been diag- Objectives: Neurogenic bladder is a multi-
nosed with Stills disease (polyarthritis with poly- factorial syndrome, with many possible clinical
arthralgia, high spiking fevers, evanescent rash symptoms. One of the etiologic cause could be
and pruritus, persistent neutrophilic leukocytosis, the cauda equine syndrome in lumbar spinal dis-
elevated ferritin serum level) two years ago in the eases with neurologic implications and it repre-
Reumatology Clinic. She was treated with Predni- sents a severe complication and one of the most
sone and Methotrexate until July 2013. The cuta- important causes of repeated acute pyelonephri-
neous eruption and pruritus rapidly disappeared. tis which if untreated and neglected, can cause in
In January 2014, she presented with a disease time, chronic pyelonephritis and then, chronic
flare that including spiking fevers, polyarthralgia, kidney disease.
a leukocytosis and markedly elevated ferritin and Methods: We conducted a study on 30 pa-
pruritic, persistent erythematous papules on the tients aged 20-70 years old, diagnosed with cau-
upper back and chest. Due to the persistent da equine syndrome, with repeated anamnestic
(fixed), pruritic papules and plaques which were acute pyelonephritis episodes. They were not in

ABSTRACTS
an acute episode when hospitalized in our clinic, with patients with AR and confirmed with AOFH
they needed catheters a demeure and underwent on IRM examination and a group B with patients
a specific physical medicine therapy (medium with AR and no AOFH. The statistical analysis was
frequency current applied lombo-suprapubian based on SPSS 20.0 and we studied the relation-
with variable intensity between 0-100Hz, 20 mi- ship and risk factors between AR and AOFH.
nutes/day, 20 days) and general bath with sapro- Results: The results respect the existing epide-
pelic Techirghiol mud (at 37 Celsius degrees, 20 miological data available from international stud-
minutes/day, 20 days), twice during a year. ies the demographic distribution, age of diagno-
Results: The recurrence of acute pyeloneph- sis moment, gender. There were no significant
ritis episodes was significantly lower (p= 0.0001) differences between the two groups, with statistic
after this balneo-physical treatment compared to association for initial onset of the disease, total
the period before hospitalization for 65% of the dose of corticoids and blood sedimentation rate
patients of the study. There were no statistical sig- (BSR).
nificance depending on the gender of the patients Conclusions: There were 24 cases with
of the study, but it was important the age of the AOFH (6.58%) diagnosed at AR patients. The
patients (better results for 20-50 years old com- treatment with corticoids was not statistically as-
paring with 50-70 years, p=0.0001). sociated with AOHF appearance; the logic statis-
Conclusions: The use of physical medicine tic regression of significant data demonstrated
and balneotherapy methods in cauda equine syn- that the only association as a risk factor for AOHF
drome with neurogenic bladder seems to be usein AR patients are the young age at the onset of
ful in reducing the number of acute pyelonephri- AR and the high levels of BSR.
tis episodes, especially for patients younger than
50 years old and could be apply as an alternative (106) Rare cause of
treatment to help preventing chronic pyelone-
phritis and chronic kidney diseases. pulmonary hypertension
due to proximal pulmonary
(102) Epidemiologic study artery obstruction case
regarding the aseptic presentation
osteonecrosis of femoral Andrei Neagu1, Ioana Andreea Ghita1,
head in rheumatoid Madalina-Maria Florea1, Andrei-
arthritis patients Alexandru Muntean1, Dragos Cosmin
Mihaela Silvia Marinica1, Consuela Zaharia1, Adelina Petria Creanga1,
Monica Brailescu1, Anatoli Eugen Miron Alexandru Bogdan2
Covaleov2, Dan Nicolae Neagoe2 1
1
Department of Physical Medicine and 2
National Institute of Pneumophtisiology Marius
Balneology, Clinical Hospital of Rehabilitation, Nasta, Bucharest, Romania
Eforie Nord, Bucharest, Romania
2
University of Medicine and Pharmacy Carol Objectives: Chronic pulmonary embolism is
Davila, Bucharest, Romania a possible cause of pulmonary hypertension treat-
able with long term anticoagulation. Severe cases
Objectives: The aseptic osteonecrosis of the with unfavorable evolution and proximal location
femoral head (AOFH) is a very severe disease due may benefit from thromboendarterectomy. Al-
to the rapid damage of the cartilage and the bone though the diagnosis is often made radiologically,
architecture, with major disability and decrease there are several rare etiologies, as in this case.
of the quality of life for the affected patients. Methods: A 63-year-old male patient is ad-
There are a lot of incriminated risk factors related mitted to the Marius Nasta National Pneu-
with the appearance of this disease; we studied mophtisiology Institute with dyspnea on moder-
the relations between AOFH and rheumatoid ar- ate exertion and repeated episodes of hemoptysis.
thritis (RA). The patient had a history of tuberculosis, deep
Methods: We conducted a retrospective stu- vein thrombosis and recurring pulmonary embo-
dy on 365 patients diagnosed with RA between lism and was under treatment with oral antico-
2012-2015 (based on ACR 1987 or ACR EULAR agulants. The patient had previously undergone
2010 criteria), divided in two groups: a group A two contrast enhanced thoracic CT (CETCT) scans

ABSTRACTS
which showed a lacunar image indicative of a Methods: We report a case of a 61 years old
thrombus at the bifurcation of the pulmonary ar- male patient, smoker, with a history of ischemic
terial trunk. Upon admission, the physical exami- heart disease and LBBB, who came to the emer-
nation is normal and the INR is within the thera- gency room for generalized erythema, accompa-
peutic range. Echocardiography suggests pulmo- nied by itching, swelling lips and eyelids, oc-
nary hypertension (PAPs = 65 mmHg) and re- curred several hours after oral ingestion of NSAIDs
veals signs of right heart decompensation and a for thoracic trauma.
hyperechogenic structure at the bifurcation of the Results: Clinical examination revealed: gen-
pulmonary arterial trunk. The patient is trans- eralized rash, scratching injuries in legs, swelling
ferred to the C.C.Iliescu Institute of Cardiovas- lips and eyelids, dyspnea, aortic systolic murmur,
cular Diseases for right cardiac catheterization absent peripheral pulse in the arms, BP 60/30
and coronary angiography. Pulmonary hyperten- mm Hg, 100 bpm. Blood tests: inflammatory syn-
sion is confirmed (PAPm = 34 mmHg). Given the drome, serum glucose 117 mg/dL, creatinine 1.3
proximal location of the lesion and apparent fail- mg/dL, blood urea nitrogen 51 mg/dL. Clinical
ure of anticoagulation treatment, thromboendar- diagnosis was anaphylaxis, allergy to NSAIDs,
terectomy is performed. Infiltrative masses are ischemic heart disease, LBBB, chronic heart fail-
extracted from both pulmonary arteries. Patho- ure. The patient was admitted in internal medi-
logical examination and Immunohistochemistry cine department of an emergency hospital. At
establish the diagnosis of leiomyosarcoma. After 2 admission: BP 60/30 mm Hg in upper limbs, 140
months, a CT scan reveals pulmonary nodules mmHg in lower limbs. ECG: sinus rhythm, 100
and mediastinal adenopathies. The patient begins bpm, LBBB. Transthoracic echocardiography: hy-
polychemotherapy. After 3 months a follow-up pertrophy of the left ventricle, LV diastolic dys-
CT shows a macronodular lesion in the left upper function type I. Cervical Doppler ultrasound re-
lobe. Bronchial aspiration reveals acid-fast bacilli veals occlusion of the left and right subclavian
and directly observed therapy is initiated. The arteries and left commune carotid artery. Thorac-
evolution is unfavorable and a cerebral CT scan ic and cervical CT confirmed the diagnosis. Arte-
reveals a solitary metastasis. Exitus occurs after 3 riography: 50% stenosis of the left anterior de-
months. scending artery, 80% stenosis at origin of
Conclusions: This case is noteworthy due to circumflex artery, and 90% stenosis at the origin
the non-embolic cause of pulmonary hyperten- of marginal branch 1. Right coronary was domi-
sion and the unusual location of the leiomyosar- nant, with occlusion in the segment II, and re-
coma, which usually occurs in the inferior vena charged by terminal branches. Occlusion of the
cava. Lack of resolution in the setting of correct right subclavian at origin, recharged in the medi-
antithrombotic therapy was an initial clue. Clini- um segment. Right vertebral artery occlusion.
cians should be aware that the differential diag- 75% stenosis of the right internal carotid artery.
nosis of lacunar images on CETCT also includes Left common carotid artery occlusion after origin,
malignant etiologies and should refer patients to a recharged by highly developed collateral branch-
specialized center for further investigation. es. Left subclavian artery occlusion at origin, re-
charged in the medium segment.
(107) Asymptomatic Cutaneous allergic signs in a patient with no
prior history of allergy have coincided with as-
multiple vascular occlusion ymptomatic severe vascular disease. This led to a
in a patient with false false clinical diagnosis of anaphylactic shock.
Conclusions: Detailed clinical examination
anaphylactic shock raised the suspicion of a vascular disease in a pa-
Alice Balaceanu, Octavian Zara, Camelia tient with typical symptoms of anaphylaxis. Ultra-
sound is a gold standard investigation for the dif-
Diaconu, Cornelia Voiculet, Giorgiana
ferential diagnoses into the emergency room.
Dediu, Camelia Georgescu, Gherorghita
Aron, Ion Dina
Objectives: Anaphylactic shock or anaphy-

laxis is an immediate type of allergic reaction that
are threatening the life of the affected person.

ABSTRACTS
(108) The role of imaging in (109) Atraumatic rupture of

stroke differential a noncoronary sinus of
diagnosis: mimics and valsalva aneurysm into the
pitfalls right atrium
Ioan-Cristian Lupescu1, Adriana Raluca Ieremia1, Marinela Serban2,
Dulamea1, Ioana G. Lupescu2 Carmen Ginghina1
1 1
Neurologic Clinic Section 1, Emergency University of Medicine and Pharmacy Carol
University Hospital, Bucharest, Romania Davila, Bucharest, Romania
2 2
Radiology and Medical Imaging Laboratory, Emergency Institute for Cardiovascular Diseases
Fundeni Clinical Institute, Bucharest, Romania Prof. Dr. CC Iliescu, Bucharest, Romania
Objectives: To present typical and atypical Objectives: Sinus of Valsalva aneurysm (SVA)
clinical and imaging features encountered in is a rare congenital or acquired condition. Unrup-
stroke. To discuss and illustrate the CT and MRI tured aneurysms are mostly discovered fortu-
technics used to diagnose ischemic and hemor- itously, being completely asymptomatic. Others
rhagic stroke. To list, comment and illustrate the present with mild symptoms due to compression
principals chameleonic non vascular conditions of adjacent structures in the heart, whereas a rup-
which can mimics stroke. tured SVA usually leads to progressively worsen-
Methods: Retrospective study of 6720 pa- ing heart failure due to acute volume and pres-
tients aged from 2 to 83 years old with sudden sure overload.
onset of a focal neurologic deficit, explored by CT Methods: We report the case of a 35 year-old
(nonenhancing CT and in particular cases also woman with no history of cardiovascular disease,
with iodinated nonionic contrast iv injection) and who addressed to our clinic with progressive dys-
/or MRI (T2, Flair, diffusion and ADC map, SWI, pnea on exertion, cough and worsening swelling
T1, 3D TOF or 3D PC to evaluate Willis polygon of the lower limbs. She had partial thyroidectomy
arteries, and in particular cases 3D T1 EG pre-/ for follicular thyroid carcinoma in 2014 and ra-
post Gd acquisition) in Fundeni Clinical Institute dioactive iodine therapy 6 months prior to admis-
in the last 5 years. sion. No chest trauma was reported.
Results: Besides ischemic and hemorrhagic On physical examination, she was intolerant
true stroke (52.5 of cases) we have found 4 prin- to supine position and had striking peripheral
cipals categories in which the clinical presenta- edema, with normal BP and a HR of 110 bpm.
tion mimicked a stroke (17% of cases): unrecog- She had no vesicular breath sounds in the base of
nized seizures with postictal deficits; systemic the right lung, and the heart sounds were masked
infections; brain tumors; toxic-metabolic distur- by a 6/6 continuous machinery murmur best
bances. More rare entities were involved: mi- heard at the left sternal border. The laboratory
graine, trauma, subdural hematoma, multiple data and the ECG were unremarkable, except for
sclerosis, positional vertigo, syncope (3.5% of sinus tachycardia. However, initial chest X-ray re-
cases). In about 27% of cases the CT and/or MRI vealed right pleural effusion.
brain evaluation did not reveal any acute isch- TTE showed dilation of the right cavities and
emic or hemorrhagic lesions. left atrium, secondary pulmonary hypertension,
Conclusions: The diagnosis of acute stroke preserved systolic function of both ventricles and
remains a clinical diagnosis in the initial phase of mild pericardial effusion. A large aneurysm of the
patients, particular in patients with with cerebro- noncoronary sinus of Valsalva was seen protrud-
vascular risk factors. There is a differential diag- ing into the right atrium. TEE was immediately
nostic process between real stroke and pseu- performed and confirmed the ruptured aneurysm
dostroke. The neuroimaging methods starting sized 28/17 mm, with continuous flow towards
with nonenhancing CT scanning and than/or with the right atrium above the septal tricuspid foil,
MRI permit the delineation between the true with a peak systolic gradient of 60 mmHg. Angi-
stroke and chameleonic stroke conditions. ography revealed normal epicardial coronary ar-
teries.
Results: High-dose diuretic therapy was initi-
ated during hospitalization, with significant im-
provement of symptoms and congestion and cva-
sicomplete remission of pleural effusion.

ABSTRACTS
Our patient underwent surgical intervention and the limits of genetic diagnostic techniques in
with successful excision of the aneurysmal pouch our practice.
and closure of the aortocardiac fistula. In conclusion, clinical judgment complemen-
Conclusions: This is a rare case of ruptured tary to genetic tests provides an accurate diagno-
noncoronary SVA which was diagnosed in time sis, prognosis and recurrence risk evaluation
and treated successfully by surgical means. Atrau-
matic rupture of the SVA is uncommon. TEE plays (115) Acute axonal
a major role in the diagnosis. Surgical interven-
tion is the definitive cure for this anomaly. sensoriomotor
polyneuropathy in SLE
(110) New genetic hemodialyzed patient case
diagnostic tests in presentation
microcephaly Lavinia Bratescu1, Marta Gemene2,
Florina Nedelea1, Anca Pavel2, Cristina Moga2, Diana Copaceanu1
Danai Stambouli3, Roxana Bohiltea3, 1
International Healthcare Systems, Centre of
Camil Bohiltea4 Nephrology and Dialysis Sf. Pantelimon,
1
Filantropia University Hospital, Bucharest, Bucharest, Romania
2
Romania University of Medicine and Pharmacy Carol
2
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
3
Cytogenomic Medical Laboratory, Bucharest, Background: Systemic lupus erythematosus
Romania (SLE) is an autoimmune disease. SLE is most com-
4
Emergency Clinical Hospital, Bucharest, mon in women between 20 and 40 years. Lupus
Romania nephritis, one of the most serious manifestations
of SLE, usually arises within 5 years of diagnosis.
Objectives: New genetic tests as array CGH Approximately 10 to 30 percent of patients with
(comparative genomic hybridization) increased proliferative lupus nephritis progress to end-stage
continuously the knowledge concerning the un- renal disease (ESRD) and needs dialysis. Acute
derline causes of genetic syndromes. Because this axonal sensoriomotor polyneuropathy is not
method could identify submicroscopic genomic common associated with SLE, even when the sis-
imbalances, we demonstrate efficacy of this test temic disease is active. Moreover, after a patient
for accurate diagnosis in a case with microcepha- starts dialysis, SLE activity is much attenuated.
ly. Methods: A female 48 years old was diag-
Methods: Conventional karyotype from pe- nosed with SLE in 2002, and treated with Medrol
ripheral blood revealed a 12p terminal deletion. and Plaquenil, complicated with aseptic necrosis
Discrepancies between clinical findings and of the bilateral femoral neck and treated total hip
karyotype results required additional investiga- arthroplasty treated in 2004. In 2007 was start
tion using comparative genomic hybridization haemodialysis (spurt severe lupus nephritis, intol-
method. erant to treatment with Cyclophosphamide, an-
Results: Array CGH revealed a 5Mb terminal tiphospholipidic syndrome - deep left leg throm-
deletion on the long arm of chromosome 10, re- bosis and left cilioretinal artery and secondary
sult that matches with the clinical findings of our hypertension). In 2014 was associated monoclo-
patient. The molecular result was verified by FISH nal gammopathy in the context of persistent hy-
analysis. This finding is consistent with a complex percalcemia (multiple myeloma was denied, al-
chromosomal rearrangement involving insertion though the patient refused bone marrow biopsy).
of genetic material from chromosome 12p to An extreme asthenia, important pain and
chromosome 10 and consequent deletion of ter- muscle weakness, initial motor deficit of the low-
minal region on the long arm of chromosome 10. er limbs followed then by the upper limbs and
Parental karyotypes are normal, suggestive of right peripheral facial paresis (paresis of a frigore)
a de novo rearrangement and consequence low appeared in Jan 2016. These symptoms were ini-
recurrence risk for other siblings. tially interpretated as a spurt of SLE activity (IgG,
Conclusions: This case report illustrates the C3, ANA, Antibodies DNAds positive), being my-
importance of considering genotype-phenotype cophenolate and methylprednisolone therapy re-
correlation for each patient and the advantages commanded.

ABSTRACTS
The patient was referred to the Neurology pitalized for acute decompensate heart failure.
Clinic, where acute axonal sensorimotor poly- Of these patients, 206 (85.12%) had a creatinine
neuropathy was diagnosed. ENG/EMG (acute de- level of less than 2.0 mg/dl. From these (with se-
myelinating polyneuropathy, motor amplitudes rum creatinine bellow 2.0 mg/dl), 47 patients
reduced by driving blocks distale), albumin-cytol- (22.81%) were positive for troponin. Patients who
ogyc dissociation of the cerebrospinal fluid (LCR) were positive for troponin had higher 30 days
sustained acute polyradiculoneuritis. CT (native mortality (10.63% vs. 3.14%, P<0.001) than
brain) showed no evidence of space-occupying those who were negative for troponin. Also, these
processes. A right femoral central venous catheter patients (with elevated troponin) had lower sys-
vein was inserted and 5 plasmapheresis sessions tolic blood pressure on admission and a lower
were conducted with improvement of symptoms. ejection fraction than those with normal tropo-
Conclusions: The first particularity of the case nin.
is the sustaining of SLE activity in HD patient. Conclusions: In patients with acute decom-
Usually, after start dialysis autoimmune systemic pensate heart failure, a positive cardiac troponin
disease shows no activity (immune deficiency sta- test at admission is associated with higher short
tus). term mortality and worse outcome. Thus, a pa-
The second feature of the case is the associa- rameter easily determinable (troponin I) can be
tion of acut axonal sensorimotor polyneuropathy used in the initial evaluation of severity of acute
with SLE, whose causal relationship has not been heart failure and to select the best management
definitely established. for this.
(119) Troponin level and (120) Fujinon thin caliber

outcome in acute heart endoscope in daily practice:
failure uses for therapeutic
Valentin Chioncel1, Raluca Banu2, application based on the
Florentina Georgescu2, Crina Sinescu1 review of 600 cases
1
University of Medicine and Pharmacy Carol Lucian Negreanu
2
Emergency Hospital Bagdasar Arseni, Bucharest, University of Medicine and Pharmacy Carol
Romania Davila, Bucharest, Romania
Cardiac troponin provides diagnostic and prog- Objective: Thin caliber endoscopes are versa-
nostic information in acute coronary syndromes, tile and useful in various conditions. However,
but its role in acute decompensate heart failure is only limited data exist on the actual daily clinical
unclear. use of such scopes especially in therapeutic pur-
Objectives: The purpose of our study was to poses. The aim of our study was to present our
describe the association between elevated cardi- experience using the Fujinon thin caliber scope.
ac troponin levels and adverse events in hospital- This scope was used with the support of Sof-
ized patients with acute decompensate heart fail- medica Romania that provided the equipement.
ure. Methods: We performed a six months retro-
Methods: We examined 242 consecutive pa- spective analysis of our database of procedures
tients with acute decompensate heart failure, with 6oo endoscopies in 567 patients. All proce-
hospitalized in our clinic between 01.01.2015 - dures were carried out in the University Hospital
01.07.2015. Entry criteria included a troponin Bucharest, between August 2015 and March
level that was obtained at the time of hospitaliza- 2016. In these procedures, the Fujinon (Tokyo,
tion (for decompensated heart failure) in patients Japan) EG-530 endscope was used and the Fuji-
without acute coronary syndrome and with a se- non 4450 processor.
rum creatinine level of less than 2.0 mg/dl (177 Results: Mean (standard deviation [SD]) age
mol per liter). A positive troponin test was de- of patients was 60 (20) years, and most (56%) of
fined as a cardiac troponin I level of 0.1 ng/ml or the patients were men. Contrarily to most studies
higher. Were used to compare Student t test and with small calibers scopes we used the endoscope
chi square and P values <0.05 were considered for all the procedures diagnostic and therapeutic
significant. performed in our unit and not only for the esoph-
Results: Troponin I was measured at the time ageal conditions. Of the procedures performed,
of admission in all of 242 patients who were hos- 42% were therapeutic. Hemostasis with needle

ABSTRACTS
injection, clips, polipectomies, PEG-gastrosto- arbitrary decided by their availability in the unit at
mies, esophageal stenting, dilations were perfor- the moment of the examination.
med. Results:The source of bleeding was identified
In comparison with regular endoscopes, the in 33 patients (83% of the cases). The most fre-
most important advantage of the small caliber quent lesions were angiomas in 14 patients, small
scope was the ability to pass esophageal stenosis bowel Crohns disease in 9 cases and NSAIDs
and placement of percutaneous endoscopic gas- enteropathy in 4 cases. Endoscopic therapeutic
trostomy (PEG), stents for esophageal tumors and procedures were used in five patients, three un-
even inspection of ileal and colonic stenosis (post dergone surgery, medical treatment was initiated
surgery or in Crohns disease). Routine use for the in 11 patients, gluten free diet in one, and discon-
clipping, injections and even band ligation (using tinuation of NSAIDs in three.
some adhesive band to stabilize the barrel on the Conclusion: Capsule endoscopy was useful in
tip of the scope) was facile. the diagnostic and the therapeutic decision in the
Conclusions: In everyday clinical practice, majority of cases. Angiomas, ileal Crohns disease
the Fujinon small caliber scope has specific ad- and NSAID enteropathy were the main causes for
vantages over conventional endoscopes because obscure bleeding. Due to capsule endoscopy ex-
of its small caliber. The main advantages are intro- amination costs, a careful and complete explora-
duction of high-grade strictures; introduction of tion of the patients with routine ileoscopy before
fistulas, including PEG fistula; and increased pa- capsule is advisable.
tient comfort.
The endoscopist should appreciate these ad- (123) Capsule endoscopy in
vantages and consider use of the small caliber
scope accordingly. young patients with iron
deficiency anaemia
(121) The role of capsule Lucian Negreanu2, Ana Stoian1,
endoscopy in obscure GI Ana Maria Negreanu2
bleeding: experience of a 1
tertiary center in Romania Romania
2
Lucian Negreanu2, Ana Maria Davila, Bucharest, Romania
Negreanu1, Ana Stemate2
1
Emergency University Hospital, Bucharest, Background: The diagnostic yield (DY) of
Romania small bowel capsule endoscopy (SBCE) is in-
2
University of Medicine and Pharmacy Carol creased in older patients but some recent data
Davila, Bucharest, Romania imply that patients 50 years are at higher risk of
sinister SB pathology. Our centre was a part of the
Objective: Obscure gastrointestinal bleeding Capsule Endoscopy in Young IDA Patients re-
OGIB represents about 5% of the digestive hem- search group(19 European centres) with the goal
orrhages. The introduction of the endoscopic vid- to investigate the DY of SBCE in a large cohort of
eocapsule in the current clinical practice caused a young patients with iron deficiency anaemia
major change in the diagnostic and treatment (IDA), and (b) factors associated with neoplastic
paradigm of these patients. pathology in this patient cohort.
Aim: In Romania capsule endoscopy is not re- Methods: We provided retrospective data of
imbursed and although available in many centers 27 patients 50 years undergoing SBCE for IDA
is not an investigation readily accessible in all pa- between January 2011 and January 2015. Exclu-
tients. Also, device assisted enteroscopy is per- sion criteria: overt-obscure gastrointestinal (GI)
formed in few centers only. We present a series of bleeding (ongoing or previous); age >50 or <19
forty patients with obscure GI bleeding and the years; comorbidities associated with IDA e.g. in-
role of capsule endoscopy in their diagnosis, flammatory bowel disease (IBD), coeliac disease.
treatment decision and follow up. For each patient, data regarding age, gender, indi-
Methods: This is a retrospective, single center cation for SBCE, investigations prior to SBCE
study. Examinations were performed using sec- [haemoglobin (Hb), mean corpuscular volume
ond and third generation small bowel capsules (MCV), ferritin, faecal calprotectin(FC) levels, im-
SB2/SB3 and the second generation of colon cap- aging, upper and/or lower GI endoscopies, biop-
sule PillCam Colon 2. The choice of capsule was sies and/or coeliac serology], medications

ABSTRACTS
(NSAIDs, antiplatelets, warfarin/heparin), SBCE nmol/L (12.2-32.8) and GH=0.25 mUI/l (0.15-
findings and final diagnosis were recorded. 2.4). The patient received medical treatment with
Results: Patients were grouped according to Sandostatin and was scheduled for surgery.
final diagnosis into the following groups: neoplas- Results: Transsphenoidal adenomectomy was
tic pathology (1/27); non-neoplastic, albeit clini- performed. After surgery IGF 1 and GH levels
cally significant, findings (13/27); normal or non- normalized, but the patient developed secondary
clinically significant findings (13/27). adrenal insufficiency and hypogonadotropic hy-
Conclusion: In our patients 50 years old pogonadism, thus he received replacement treat-
with IDA, the overall DY of SBCE (for significant ment with Prednison 5 mg daily and testosterone
findings) is 51.8%. However, our results were treatment (Nebido 1000 mg/4 ml, one vial every
more promising that those of the study group 12 weeks).
were the DY was 32,3%. More prospective stud- Conclusions: Central diabetes insipidus is a
ies with a larger sample of patients with this pa- well-known complication of pituitary tumors or
thology are required. surgical treatment of pituitary gland. In this case
though, the patient had developed an idiophatic
(124) Pituitary central diabetes insipidus in his childhood and
the secreting pituitary adenoma decades after, so
macroadenoma following there is no link between the two pathologies. The
diabetes insipidus onset patient presented postoperative complications
(pituitary insufficiency) that require long term
decades apart case hormonal replacement therapy and medical fol-
presentation low-up.
Alexandra Corbu1, Monica Roxana

Ionita1, Sorina Martin2, Alexandra Nila3, (131) Management of
Simona Fica3 pulmonary hypertension in
1
University of Medicine and Pharmacy Carol a patient with rheumatoid
Davila, Bucharest, Romania arthritis case report
2
Department of Endocrinology, Elias Hospital,
University of Medicine and Pharmacy Carol Oana-Mihaela Inta1, Roxana Enache2,
Davila, Bucharest, Romania Pavel Platon2, Carmen Ginghina1
3
Department of Endocrinology, Elias Hospital, 1
Emergency Institute for Cardiovascular Diseases
Bucharest, Romania Prof. Dr. CC Iliescu, Bucharest, Romania
2
Objectives: Pituitary adenomas are the most Davila, Bucharest, Romania
common etiology of sellar masses and they usu-
ally present with neurologic symptoms, hormonal Objective: Pulmonary hypertension (PH) is an
abnormalities or are found incidentally on mag- uncommon complication of rheumatoid arthritis
netic resonance imaging (MRI). The tumors can (RA), usually in the setting of parenchymal lung
arise from any type of cell of the anterior pituitary involvement or like isolated pulmonary hyperten-
and may result in increased secretion of the sion.
hormone(s) produced by that cell and/or de- Methods: We present a case of 61-year-old
creased secretion of other hormones due to com- female, diagnosed with RA, without history of
pression of other cell types.Central diabetes in- cardiovascular diseases, admitted for dyspnoea.
sipidus is a pathology often idiophatic, but it can Transthoracic echocardiography detected right
also occur in cases of pituitary tumors compress- cavities dilatation with right ventricle free wall hy-
ing the pituitary stalk. pertrophy and mild right ventricular longitudinal
Methods: We describe the case of a 53 years systolic dysfunction. Based on moderate tricuspid
old male patient diagnosed with central diabetes regurgitation we estimated a value of 103 mmHg
insipidus at the age of 3, who developed a GH for PAPs. Ventilation/perfusion lung scan showed
secreting pituitary macroadenoma in 2010. The multiple bilateral hypoperfusion areas, predomi-
patient had acromegaly symptoms since 2009 nantly right and pulmonary CT angiography de-
and an MRI scan performed in 2010 showed a tected parietal thrombosis of right lobar pulmo-
pituitary macroadenoma (10/8.6/7.8 mm) locat- nary arterial branches and dilatation of the
ed on the right half of the gland. The hormonal pulmonary artery. Compression venous ultraso-
profile showed elevated levels of IGF1= 169.4 nography did not identify signs of deep vein

ABSTRACTS
thrombosis and thrombophilia tests were nega- 2015, treated with levodopa / carbidopa intesti-
tive. The cardiac catheterization confirmed the nal gel. We analyzed demographic, clinical and
presence of precapillary PH with increased pul- laboratory data of the subjects and also those re-
monary vascular resistance (582 dynes/cm5) and lated to the therapy.
the pulmonary arteriography revealed right pul- Results: The average age of patients was
monary artery thrombosis with the lower and 68.05 years and the mean duration of the evolu-
middle lobar branches amputation. tion of the disease before the therapy with intes-
In the presence of thromboembolic PH even tinal gel was initiated was 10.55 years, so forms of
without affected main branches, but with in- the disease with onset before the age of 65 years.
creased pulmonary vascular resistance in a pa- The maximum dose in the continuous infu-
tient with NYHA functional class III, without ma- sion of levodopa was on average 1500mg / day
jor comorbidities, pulmonary endarterectomy (excluding morning dose and possible overdose).
was performed. After surgery, persistent PH was Initiation of this treatment was due to the oc-
detected and was initiated sildenafil with favor- currence of motor complications.
able hemodynamic and clinical evolution. In terms of increased incidence of comorbidi-
Results: Patients with RA have high levels of ties we noticed anxious depressive disorders.
TNF and homocysteine, that favors thrombotic Therapy complications studied were persis-
events, including thromboembolic PH. Despite tent occurrence of dyskinesias and psychiatric
apparently successful pulmonary endarterectomy, disorders with hallucinations, thought disorder
some patients may have persistent PH. The most and psychomotor agitation type delusional inter-
probable cause is concomitant small-vessel arteri- pretations.
opathy, which was favored in our case by proin- Local level stoma complications were encoun-
flammatory status of RA. Treatment with PAH- tered in 10% and could be quickly resolved with-
approved drugs is recommended for patients out causing abandoning treatment.
with persistent PH after surgery, as well as for Conclusions: The therapy was generally well
technically non-operable patients or in the pres- tolerated and patients reported improved quality
ence of an unacceptable surgical risk: benefit ra- of life, improving functionality, disposition, and
tio. relationships with tutors.
Conclusions: Pulmonary endarterectomy
should be recommended to all eligible patients (140) Hairy cell leukemia:
with thromboembolic PH. Correct diagnosis (by
cumulating clinical data with imaging and inva- favorable and unfavorable
sive evaluation) to differentiate thromboembolic prognostic factors
PH from other types of PH is particularly impor-
tant. Mihnea-Alexandru Gaman
(135) Assessment of Davila, Bucharest, Romania
advanced therapy in Objectives: Hairy cell leukemia (HCL) repre-
Parkinson disease sents a chronic, malignant, lymphoproliferative
disorder characterised by splenomegaly, pancyto-
Ioana Cociasu, Eugenia Irene Davidescu, penia and neutropenia. Through electronic or
Anodine Daliko Nishimwe, Ioan Buraga phase contrast microscopy, in the peripheral
University of Medicine and Pharmacy Carol blood or red bone marrow, hairy cells, peculiar
Davila, Bucharest, Romania B-lymphocytes of the spleen or red bone marrow
which can enter the bloodstream, can be ob-
Objective: Parkinsons disease (PD) is one of served. We aim to record the therapeutic results
the most common neurodegenerative diseases, and prognostic factors for a favourable evolution
and currently, thanks to advances made by medi- of the disease and the factors which favour an
cal research, patients benefit from a variety of the adverse evolution.
latest generation therapies. This paper addresses Methods: We conducted a retrospective
the therapy with levodopa / carbidopa intestinal study on 16 patients with HCL in the Clinic of
gel. Hematology from Craiova in between 2009 and
Methods: we performed a retrospective co- 2013. We analysed the global response rate to
hort study of 20 patients with PD (12 men and 8 specific therapy, mean rate of survival based on
women) who were hospitalized during 2012- therapy and the disease free interval based on the

ABSTRACTS
observation sheets, histopathological bulletins, Methods: The patient was admitted to the
immunohistochemistry results and therapeutic Clinic of Hematology from Craiova, Romania, for
protocols. The patients were divided into groups pallor, fever (39.50 C), hydrosis, type II malnutri-
based on age, sex, clinical types of disease. We tion, several bruises on the legs, liver edge pal-
recorded the therapeutic effects, complications, pated 2 cm from the costal margin, impalpable
relapses, prognostic factors which influenced the spleen. Diagnostic tests revealed RAEB-II, auto-
therapeutic response. The patients were treated immune hemolytic anemia (AIHA) and polysero-
with interferon (IFN) alpha-2 (3 x 106 interna- sitis.
tional units x 3 / week). The results were statisti- Results and conclusions: Bone marrow smear
cally analysed using the Kaplan Mayer method. revealed megaloblasts and giant erythroblasts. All
Results and conclusions: 68.75% of the pa- tests depicting a suprainfection with fungi were
tients responded to therapy: 31.25% complete negative. The tomography of the thorax uncov-
response, 12.5% partial response and 25% stable ered retrosternal and paratracheal adenopathies
disease. The complete response appeared after with central necrosis. The patient developed
the first three months of therapy and lasted for thermoregulatory disorders, followed by a confu-
3-5 years. The main adverse effects of therapy sional state. The MRI scan showed demyelination
have been weight loss, depression, flu-like syn- of the subcortical white matter. Despite treatment
drome. After therapy, the favourable prognostic with antibiotics (Cefort + Gentamicine, then Me-
factors were a decrease registered in the need of ropenem + Vancomycin) combined with Exjade
blood transfusion (63%), the number of hairy cells therapy, the disease evolved unfavorably. The
in the bone marrow/peripheral blood (55%), the specific therapy was with cytarabine in mini-dos-
incidence of infections (72%), and an increase in es and dexamethasone. The patient remained
the number of thrombocytes (64%), leukocytes febrile, in spite of antiviral and antifungal treat-
(61%), hemoglobin value (84%) and polymorpho- ment. After two months, the CT scan revealed
nuclear cells (55%). Unfavourable prognostic fac- adenopathies in the mediastinum. The analysis of
tors were the presence of ascites, abdominal ad- saliva, pleural and ascitic fluid eventually high-
enopathies, opportunistic infections with lighted infection with Mycobacterium tuberculo-
Mycobacterium or Gram-negative bacteria, the sis, confirming the diagnosis of polyserositis, in
coexistence of autoimmune hemolytic anemia, addition to RAEB-II and AIHA.
the development of a secondary neoplasm. Treat- Despite antitubercular treatment with a
ment with IFN alpha-2 was useful in 27% of the scheme of four different drugs (Isoniazid 300 mg,
patients previously treated through other thera- RMP 450 mg, Pyrazinamide 1250 mg, Ethambu-
pies. tol 1800 mg), the patient continued to be febrile
and pancytopenic (RAEB-II treated with Cytosar).
(141) Prolonged febrile The evolution and prognosis remained reserved.
The case peculiarity is that tuberculosis of the he-
syndrome caused by matopoietic organs was correlated with pancyto-
tuberculosis of the penia and did not have a leukemoid origin due to
an association with RAEB-II.
hematopoietic organs in a
patient with refractory
anemia with excess blasts,
autoimmune hemolytic
anemia and polyserositis
Mihnea-Alexandru Gaman
Objectives: Refractory anemia with excess

blasts (RAEB) is a myelodysplastic syndrome in
which the percentage of blasts in the bone mar-
row ranges from 5% to 19%. We aim to report the
case of a patient with RAEB-II with febrile epi-
sodes that alternated with hypothermia.

ABSTRACTS
(146) The importance of the assessment of the multitude of data provided

by modern genetic technology. The existance of a
unified comprehensive large database containing all the current BRCA
BRCA databases in next knowledge would not only help physicians in ac-
curately interpreting the implications of these
generation sequencing variants in cancer etiopathogeny, but would also
clinical interpretation lead to the correct identification of novel patho-
genic variants.
V. Radoi1, R. Ursu2, G. Chelu3, G.
Cardos2, C. Arsene1, Roxana Bohiltea2,
Camil Bohiltea3
(147) Utility of array
1
Comparative Genomic
Davila, Bucharest, Romania Hybridization (ACGH) in
2
Department of Medical Genetics, SYNEVO, the accurate evaluation of
Bucharest, Romania
3
Central Laboratory, Bucharest, Romania patients with unspecific
dysmorphic features and
Background: BRCA1 and BRCA2 gene muta- multiple congenital
tions account for 20-25% of hereditary breast
cancers and about 5-10% of all breast cancers. In abnormalities
addition, mutations in these genes account for
R. Ursu2, V. Radoi1, G. Chelu3,
about 15% of all ovarian cancers. The BRCA1 and
BRCA2 have been the most studied and reported G. Cardos2, C. Arsene1,
genes in the human genome over the past de- Roxana Bohiltea2, Camil Bohiltea3
cades. 1
Objective: The using of cutting-edge genetic Davila, Bucharest, Romania
analysis technologies imposes the existance of 2
Department of Medical Genetics, SYNEVO,
large comprehensive genomic databases for an Bucharest, Romania
accurate clinical interpretation. At the same time, 3
Central Laboratory, Bucharest, Romania
these modern diagnostic techniques lead to the
identification of novel variants with unknown or Background: The array comparative geno-
controversial clinical significance which raise mice hybridization technique (aCGH, molecular
great challenges for the clinicians in the analysis. karyotype) has become one of the most impor-
Methods: A review of the main BRCA data- tant diagnostic tools in identifying genomic ab-
bases (1000 genomes, ClinVar, NCBI, SNPedia, normalities associated with developmental dis-
PharmGKB, OMIM, COSMIC, UCSC Genome abilities (congenital malformations, cognitive
Browser, BioGPS, etc.) and professional work- impairment and behavioral disorders, microdele-
groups guidelines and recommendations has tion and microduplication syndromes).
been performed for a comprehensive outline of Objective: The purpose of this presentation is
the current knowledge on BRCA variants associ- to describe the optimal medical genetics evalua-
ated with hereditary breast and ovarian cancer. tion and diagnosis of the child with intellectual
Different classification categories proposed by disability and global developmental delay.
leading national and international professional Method: Study group consists of 8 children
societies have been taken into consideration. with epileptic enephalopathy, hypotonia, psycho-
Results: By analyzing the above-mentioned motor impairment, different forms of epilepsy,
databases and variant classes we observed slight microcephaly, intellectual disability.
differencies between the variant clinical correla- Constitutional karyotyping has been per-
tion classification criteria, number of classes and formed in all the cases with normal findings.
especially terminology used to define these class- The next diagnostic step in the management
es. These discrepancies tend to produce confu- of the patients has been the molecular karyotype
sion when in terms of analysis and clinical inter- (aCGH) on an Agilent platform using SurePrint G3
pretation, some variants with uncertain signifi- CGH ISCA v2 Microarray, 8X60K. Data analysis
cance being extremely difficult to categorize, and clinical interpretation have been completed
with consequences in managing the patients. using the Agilent CytoGenomics 3.0.2.11 Soft-
Conclusions: In conclusion, establishing a ware, ADM-2 algoritm.
unified BRCA database would be of great value in

ABSTRACTS
Results: The results revealed pathogenic vari- and hyper-alpha-2-globulinemia.

ants in 4 cases: In the 10th day of admission, the patient com-
Microduplications with pathogenic signifi- plains of intense frontal headache and photopho-
cance (correlated with the clinical indications) - 2 bia. These symptoms persisted over the next 4
cases: 1p36.32; 8p23.1. days, so a cerebral MRI with contrast agent was
Microdeletions with pathogenic significance performed showing thrombosis of the right trans-
(correlated with the clinical indications) - 2 cases: verse and sigmoid venous sinus. The diagnosis is
14q31.1; 1p36.33-p36.23. supported by elevated D-dimer values and by the
Microdeletions and microduplications with altered coagulogram.
benign or uncertain significance (according to Nephrotic syndrome was resolved during hos-
current genetics knowledge) - 4 cases. pitalization with diuretic and corticosteroid treat-
Conclusions: Although array-CGH is current- ment. For the thrombotic complications, the pa-
ly being used as a complementary test to standard tient is receiving anticoagulant therapy.
cytogenetic techniques, it is likely to become the Conclusions: The particularity of the case lies
genetic test of choice, especially in cases of idio- in the possibility of existence of a viral infection as
pathic developmental delays, epilepsy, multiple a trigger of the nephrotic syndrome, the mother
congenital anomalies microdeletion and micro- being confirmed with AH1N1 influenza type in
duplication syndromes. PCR examination, as well as the the occurence of
venous sinus thrombosis as a complication of this
(149) Cerebral venous syndrome. The diagnosis of the venous sinus
thrombosis should be considered in patients with
thrombosis a rare nephrotic syndrome and neurological symptoms,
complication of nephrotic as early diagnosis is correlated with favorable re-
sults.
syndrome
L. E. Brezeanu1, O. P. Calapod1, (152) Benefits of beta
M. Neboleanu1, G. Ion2 blockers in patients with
1
University of Medicine and Pharmacy Carol chronic heart failure
2
Emergency Clinical Hospital for Children Razvan Pargaru1, Andrei Gila1, Erick
Grigore Alexandrescu, Bucharest, Romania Nestianu1, Ilke Zervri1, Nicolae Lucian
Axente1, Crina Sinescu1,2
Objective: Nephrotic syndrome is associated
1
with a hypercoagulable state and an increased University of Medicine and Pharmacy Carol
risk of thromboembolic complications. Cerebral Davila, Bucharest, Romania
2
venous sinus thrombosis is a rare complication of Emergency Hospital Bagdasar Arseni, Bucharest,
the nephrotic syndrome, with few cases described Romania
in the literature, although the disease may be un- Heart failure has a growing prevalence in the
derdiagnosed. The true incidence of cerebral ve- world, approximately 1-2% of the adult popula-
nous sinus thrombosis may be underestimated tion in developed countries and over 10% among
because many events are asymptomatic or are persons of 70 years or older.
not diagnosed in time. Objectives: To summarise evidence about
Here, we describe the case of a female child, treatment with beta-blockers in heart failure with
6 years old, presenting with nephrotic syndrome, reduced ejection fraction.
who complained of serious headache during hos- Method: Our review is based on the data col-
pitalization. lected from three clinical trials: The Cardiac In-
Methods: A 6 year old pacient is hospitalized sufficiency Bisoprolol Study II (CIBIS-II), Effect of
in our clinic with: eyelid edema for the past 3 carvedilol on the morbidity of patients with se-
days, cough and seromucous rhinorrhea in the vere chronic heart failure: results of the carvedilol
context of a viral infection suggested by the respi- prospective randomized cumulative survival (CO-
ratory symptoms of both parents. PERNICUS) study and Effect of metoprolol CR/XL
Clinical examination reveals eyelid and pe- in chronic heart failure: Metoprolol CR/XL Ran-
ripheral edema. Laboratory investigations show domised Intervention Trial in Congestive Heart
nonspecific inflammatory syndrome, severe pro- Failure (MERIT-HF).
teinuria, hypercholesterolemia, hypertriglyceri- Results: Patients with IIIV NYHA heart fail-
demia, hypoproteinemia with hypoalbuminemia ure, already receiving appropriate medical thera-

ABSTRACTS
py, including diuretics, angiotensin converting supporting the idea of family. Understanding this
enzyme inhibitor (ACE inhibitor) or angiotensin II fact, the medical society runs studies in order to
receptor blocker (ARB), nitrates and digitals, start- minimize or even to eliminate the maternal risks.
ed Bisoprolol 1.25mg daily, progressively in- In this case, it was developed a tehnique of a long
creased to the target dose of 10 mg per day (CI- term freazing of the embryo which reduces the
BIS-II) showing 11.8% decrease in mortality and hormonal treatment complications. Introducing
3.6% reduction in suden cardiac death. Treat- this procedure in all in vitro fertilization cases it is
ment with carvedilol 3.125 mg per day, gradually also minimized the risk determined by the age of
rising to 25 mg daily (COPERNICUS) demonstrat- the mother. Therefore, the viability of the embryo
ed reduced risk of death and 27% reduce in hos- increases.
pitalisation. Patients treated with Metoprolol 25 Conclusion: The latest studies underline the
mg per day up-scaled to the target dose of 200 maternal risks after in vitro fertilization and also
mg daily (MERIT-HF) had 7.2% lower all-cause they show that this tehnique is still developing to-
mortility and 11%, decrease in sudden cardiac wards a minimalization of the side efects. Know-
death. ing that almost 2% of the babies born every year
Conclusion: All data concluded that beta- are the result of in vitro fertilization it is necessar-
blockers are well tolerated and have a beneficial ily to society to invest money and effort into hu-
effect on patients with II-IV NYHA heart failure man assisted reproduction field.
reducing hospitalization, morbidity and mortality.
(159) K-RAS gene status in
(158) In vitro fertilization: metastatic colorectac
maternal side effects and carcinoma patients
risks
Florina Cionca
Alexandra Ondu, Diana Troncota, Diana National Institute of Pathology Victor Babes,
Fraticiu Bucharest, Romania
Davila, Bucharest, Romania Background: K-ras gene has a major role in
the anti-EGFR therapy of metastatic colorectal
Objectives: We want to discover all the risks carcinomas (mCRC). The purpose of this study is
that a future mother assumes when she decides to identify possible correlations between the K-ras
to get birth to a baby using in vitro fertilization. Of mutation status and clinical and histopathological
course in vitro fertilization has a lot of benefits, findings of patients with mCRC.
but how many comparing to all the risks? Our pri- Methods: Our study included formalin-fixed
mary concern was to answer to this question. paraffin-embedded tissue samples from 256 pa-
Method: We studied the articles and the latest tients with mCRC, aged between 33 and 79 years
research appeared in the international publica- old, sex ratio 1,4:1, with different metastatic lo-
tions. calizations (liver, pulmonary, ovarian, uterine,
Results: The maternal risks determined by in lymph nodes, mandibular, muscle, peritoneal and
vitro fertilization procedure know a wide range of cutaneous metastases). The Ki67 nuclear protein,
symptoms which can lead to further severe com- associated with cellular proliferation, was ana-
plications. Firstly, the hormonal treatment used lyzed using an indirect bistadial immunohisto-
for follicle stimulation represents the etiology of chemical (IHC) technique with monoclonal anti-
ovarian hyperstimulation syndrome (OHSS). bodies, performed with Dako EnVision+ Dual
Moreover, the frequency of ectopic or multiple Link System-HRP. K-ras gene mutations in codons
pregnancies, spontaneous abortion or premature 12 and 13 of exon 2 were detected by PCR-Re-
birth in the first trimester of parturation is rela- striction Fragment Length Polymorphism analysis.
tively high (12-20%). There is also a concern Results: K-ras mutations were present in 39 %
about the emotional implications involved in the of the cases, 90 patients with mutations in codon
in vitro fertilization method. The medical society 12 (35%, sex ratio 1.14:1) and 10 patients with
emphasizes not only the clinical problems but mutations in codon 13 (4%, sex ratio 1.5:1). Im-
also they give value to the psihical issues which munohistochemical expression of Ki67 protein
can diminish the rate of succes of the procedure. was positive in half of all cases, with values be-
The benefits resulted from in vitro fertilization are tween 1% and 90%. The majority of mCRC were
clear and they have an important social impact by moderately differentiated adenocarcinomas, de-

ABSTRACTS
spite the type of the K-ras gene, wild or mutated, netics or the FISH method was successfully
or the mutation position. Compared analysis, in- achieved in 160 cases. FISH was mainly used for
cluding presence and localization of K-ras muta- samples who did not meet the preanalytical con-
tions, the patients sex and age, localization of ditions established by our laboratory.
primary tumour and metastases, histological tu- Of the analyzed cases, 84 (52.5%) had an ab-
mour grading and the Ki67 protein IHC reaction, normal karyotype and in 76 cases (47.5%) no
did not reach statistical significance. structural or numerical chromosomal abnormali-
Conclusions: Finding no important correla- ties were identified.
tions between clinical and histopathological char- Among the abnormal cases we identified: 47
acteristics of patients with mCRC and the muta- homogeneous autosomal trisomies, 4 mosaic ab-
tional status of the K-ras gene demonstrates once normalities, 4 unbalanced structural chromosom-
more the major role of molecular tests in opti- al abnormalities, one balanced translocation, 1
mized selection of mCRC patients eligible for an- case with trisomy and unbalanced structural
ti-EGFR therapy. chromosomal aberration, eight triploidies, two
tetraploidies, 13 monosomy X, 2 double autoso-
(162) The utility of mal trisomies, one triple trisomy and one clonal
chromosomal instability.
conventional cytogenetics Results: The results of our study sustain the
and FISH analysis in the importance of cytogenetics analysis for miscar-
riages. Depending of the results, the recurrence
diagnosis of the products of risk for the chromosomal abnormality identified
conception may be estimated. In addition, the results are use-
ful in the counseling of couples who are trying to
Monica Stoian, Laurentiu Camil understand why their pregnancy ended in mis-
Bohiltea, Rahimian Hadi, Manuela carriage. Genetic counseling is best provided be-
Neagu, Cristina Ionescu, Georgiana fore the next pregnancy, so all options may be
Petrica-Matei, Roxana Constantin, explored and appropriate planning may be as-
sured.
Roxana Bohiltea
(164) Inoperable medullary
thyroid carcinoma: a case
Approximately 15% of all clinically recognized report
pregnancies are spontaneously aborted.
With respect to the various possible etiological Ioana Cotofana1, Roxana Rosca1
factors of developmental defects in early abortion Maria Olaru2, Anda Dumitrascu1,
specimens, cytogenetic analysis is an important Dumitru Ioachim1, Andrei Liviu
component in the assessment of human malfor-
mation in early failed pregnancies.
Goldstein1, Diana Loreta Paun1
1
Objectives: The objective of our study was to National Institute of Endocrinology C. I. Parhon,
determine the frequency of chromosomal abnor- Bucharest, Romania
2
malities in miscarriages. University of Medicine and Pharmacy Carol
During November 2012 - April 2016, 165 Davila, Bucharest, Romania
samples were analyzed by conventional cytoge-
netic methods or FISH (fluorescence in situ hy- Objectives: Medical attitude in the case of a
bridization) technique. 73-year-old female with inoperable MTC, euthy-
Methods: The analyses were performed for roid status, and an elevated calcitonin value, with
early miscarriages or for induced pregnancy ter- nonspecific ultrasound aspect, but with specific
mination due to severe fetal ultrasound abnor- scintigraphy aspect and with confirmation of the
malities. The samples evaluated were from prod- diagnosis through fine needle aspiration, without
ucts of conception between 6 and 23 weeks of apparent metastases.
pregnancy, in patients aged between 23 and 43 Methods: We report the case of a 73-year-old
years. woman, hypertensive, cardiac, and recent diag-
Depending on the biological sample received nosis of atrial fibrillation, who addressed our de-
from the gynecologists, either, chorionic villi, epi- partment for thyroid/ anterior cervical level dis-
thelial tissue, amniotic fluid or fetal cord blood comfort, breathlessness, fatigability, and weight
was used for analysis. The conventional cytoge- loss. There was no relevant family history of thy-

ABSTRACTS
roid disease. The patient presented euthyroidism, motor manifestations, the presence of cardiovas-
with elevated ATPO value, and elevated calcito- cular comorbidities, the values of glycaemia,
nin value 23.200 pg/ml. Thyroid ultrasound re- Hb1Ac, lipid profile and other co-morbidities.
vealed a goitre increased in size along with the Statistical correlations among these parameters
presence of a thyroid node at the level of the left have been calculated.
lobe, hypoechogenic, inhomogeneous, heavily Results: We have identified 92 PD patients
vascularized of about 2/3 cm, and a second thy- (59 men, 33 women) between 56 73 years-old,
roid node at the level of the right lobe, hypoecho- among 61 (66.30%) had a severe Hoehn & Yahr
genic, inhomogeneous, with peri- and intranodu- stage (4-5), and 51 (55.43%) had significant cog-
lar vascularity, minim adenopates unless 1cm. We nitive deterioration (mild cognitive impairment or
performed thyroid scintigraphy, cytopathology dementia ); 50 (54.35%) patients had associated
examination by fine needle aspiration and a CT HTA. A high incidence of cardiovascular comor-
scan of the neck, thorax, mediastinum, and abdo- bidities and vascular risk factors in patients with
men to disclose the thyroid aspect and potential PD has been found. The most significant correla-
secondary determinations. tion (p=0.04) was between the clinical severity of
Results: From an endocrinology point of view Parkinsons disease and the presence of the bio-
a surgical cure is indicated, but the opinions of logic inflammatory syndrome.
both a cardiology and intensive care specialist are Conclusions: Our study indicate that there is
to postpone the surgery in order to perform car- a significant correlation between the presence of
diologic reevaluation and stabilize the patient an inflammatory syndrome and the severity of
from this perspective. The current indication, Parkinsons disease, both related to the motor
given that the tumour is inoperable at this time and non-motor signs, including neurocognitive
due to the associated pathology, is according to impairment and to the presence of cardiovascular
some studies external cervical radiation. In this comorbidities. In a further study, we shall look if
context we request oncologic opinion. the level of vitamin D also correlates with these
Conclusions: We present the case of a abnormalities, given the recent scientific data in-
73-year-old female with inoperable MTC, euthy- dicating low vitamin D level as a risk factor associ-
roid status, and an elevated calcitonin value, with ated with PD, and also a possible correlation be-
nonspecific ultrasound aspect, but with specific tween the low level of vitamin D and microglial
scintigraphic aspect and with confirmation of the hyperactivity. These results could imply the need
diagnosis through fine needle aspiration, without to extend the therapeutic protocols for PD pa-
apparent metastases. The recommended treat- tients, for a specific CNS anti-inflammatory strat-
ment because of the associated diseases seems to egy in parallel with the treatment of the potential
be external local radiation therapy. peripheral causes of inflammation.
(173) Metabolic (174) A case of metatypical

abnormalities associated carcinoma in a patient
with Parkinson disease without evident risk factors
Ovidiu-Lucian Bajenaru, Cristina Tiu, Madalina Irina Mitran1, Cristina Iulia
Elena Terecoasa Mitran1, Maria Isabela Sarbu1, Mircea
University of Medicine and Pharmacy Carol Tampa1, Clara Matei2, Vasile Benea2,
Davila, Bucharest, Romania Simona Roxana Georgescu2
1
Department of Dermatology, Hospital of
Objectives: The main objective of the study is Infectious and Tropical Diseases Victor Babes,
to identify possible correlations among different Bucharest, Romania
metabolic abnormalities and the pathophysiologi- 2
cal and clinical characteristics of Parkinsons dis- Davila, Bucharest, Romania
ease (PD).
Methods: We have studied in a retrospective Objectives: Metatypical carcinoma (MTC),
research, the medical documents of all patients also known as basosquamous carcinoma, is an in-
hospitalized with the diagnosis of PD during vasive slow growing tumour with increased ca-
2015, in the Neurology Department University pacity of recurrence and metastasis, accounting
Emergency Hospital Bucharest. We have collect- for 1.5% of skin neoplasms. Clinically, it does not
ed data on clinical stage of PD, motor and non- display specific characteristics, but often resem-

ABSTRACTS
bles basal cell carcinoma (BCC), therefore the di- procedures or, less frequently, with chest trauma.
agnosis is based on histopathological examina- The course of PMAIVF is presently unpredictable
tion. MTC was more frequently diagnosed in with possible complications determined by com-
older persons, especially in the seventh decade of pression or rupture into nearby anatomical struc-
life, with a male predominance. tures, although, in some cases, no significant cli-
Method: A 75-year-old woman presented to nical events were reported.
the dermatology department of our hospital with Methods: A 71-year old male with aortic
a 5 months history of a round-oval proliferative, valve replacement for severe regurgitation due to
asymptomatic lesion located on her chin, which aortic bicuspidy is admitted for palpitations, chest
slowly increased in size. Her medical history was pain and shortness of breath, which started one
unremarkable. She was not chronically sun ex- week before presentation. ECG revealed a heart
posed and she never smoked. rate of 150 bpm due to atrial flutter, converted to
Results: The physical examination showed a sinus rhythm after 5 days of antiarythmic treat-
healthy appearing patient with the vital parame- ment. Blood tests showed therapeutic values of
ters within the normal range. The dermatological INR, elevated BNP and negative blood cultures.
examination revealed a round-oval proliferative Transthoracic echocardiography was performed,
lesion, 0.5/0.7 in size, with a translucent surface with normal prosthetic aortic valve movements,
and several peripheral small nodules, located on left atrial, aortic root and ascending aorta dilation.
the right side of her chin. The superficial lymph Posteriorly to the aortic ring, TTE revealed a pul-
nodes were not enlarged. The clinical appear- satile cavity, followed by transesophageal echo-
ance of the tumour raised the suspicion of BCC. cardiography confirming a pseudoaneurysm of
The tumour excision and a biopsy were per- the mitral-aortic intervalvular fibrosa, with left
formed. The histopathological examination re- ventricle communication (observed by color and
vealed tumour cell proliferation with characteris- continuous Doppler). We couldnt identify a
tics of both BCC and SCC, evoking the diagnosis communication to the ascending aorta by TEE,
of MTC. The patient underwent radiotherapy ruled out by thoracic CT scan, which was also
with favourable evolution. She remains under the useful for precise localization and measuring of
supervision of the dermatology department in or- PMAIVF.
der to diagnose recurrences or metastases in an Results: Negative blood cultures results, lack
early stage. of specific echocardiographic and clinical find-
Conclusion: We present the case of MTC in a ings, were arguments against infective endocardi-
patient without evident risk factors. The tumour tis. The surgical option was debated, although
being diagnosed in an incipient stage, an excision reintervention was considered high-risk proce-
with clear histologic margins, without aesthetic dure (Euroscore II). Conservative management
implications, was performed. was chosen considering lack of local complica-
tions and previous experience documented by
(176) Pseudoaneurysm of small-sample studies and case reports, although
periodic reevaluation through TEE is required.
the mitral-aortic Surgical approach will be considered in case of
intervalvular fibrosa a rapid progression or development of complica-
tions.
rare complication after Conclusion: Diagnosis of pseudoaneurysm
aortic valve replacement was established late after aortic valve replace-
ment (13 years after the procedure) and though
Bogdan Arsenie1, Aura Popa2, Marinela the PMAIVF dimmensions were significant, no lo-
Serban2, Crina Radulescu1, Dana Tabac2, cal complications appeared.
Razvan Vasile2, Carmen Ginghina1,2
1
Emergency Institute of Cardiovascular Diseases
Prof. Dr. C.C. Iliescu, Bucharest, Romania
2
Objectives: Pseudoaneurysm of the mitral-

aortic intervalvular fibrosa (PMAIVF) is a rare, po-
tentially life-threatening complication, associated
with infective endocarditis, aortic valve surgical

ABSTRACTS
(178) The multidisciplinary (179) Telocytes (ultra)

evaluation of an acromegaly structural changes in
patient psoriatic skin
Maria Sabina Safta Catalin Gabriel Manole, Mihaela
University of Medicine and Pharmacy Carol Gherghiceanu, Olga Simionescu
Davila, Bucharest, Romania Department of Cell Biology and Histology,
Objectives: The report I am bringing to your Davila, Bucharest, Romania
attention focuses mainly on the importance of the
para-clinical aspects and differential diagnosis in Objectives: In 2012 telocytes (TCs) were de-
a case report. This investigation is not only an en- scribed into the dermis of the normal skin as a
docrinological case where a hormone is not re- new type of stromal cells. Dermal TCs were docu-
leased properly, and a random treatment is given mented to do networking, defense (immunologic
to replace it, its much more. We have to look targets), secretion (paracrine) and nursing for
deep, in between the lines. How do this condi- stem cells. Although dermatology encompasses
tion and its diverse symptoms affect the rest of the mode than 2000 diseases, TCs were previously
body and the quality of life? How deep does Ac- described in systemic sclerosis, only. This study
romegaly go into our system? We may even go as aims to present the dynamics and distribution of
far as how does it influence cortical activity when TCs in the psoriasis vulgaris. We also aim to inves-
taking into account paraclinical evaluations. Even tigate the (ultra)structural changes of dermal TCs
looking on a pathological slide of the hypophy- of patients with psoriasis vulgaris.
seal macroadenoma its a start of a discussion. In Methods: 10 patients diagnosed with psoria-
simple words, the objectives are to prove the rel- sis vulgaris were punch-biopsied 3 times, each
evance of paraclinical aspects, except clinical as- from: a) mature lesion;
pect, in a case of acromegaly. b) distant uninvolved skin and
Methods: its starts off with the physical and c) after the clearance induced by topical ther-
endocrinologic examination trying to put accent apy. The entirely treatment was topic using ket-
on the patients medical history. One of the most atolytic and cytoreduction, followed by calcipot-
important implications is the hypophyseal mac- riol and local steroids. For documenting psoriatic
roadenoma of size of 40/25 mm. This was reme- skin TCs distribution and also their spatial ar-
diated by a trassphenoidal adenomectomy leav- rangement several microscopy techniques were
ing a 15/4 mm tumoral rest and a transitory employed: transmission electron microscopy, im-
gonadotropic insufficiency; this is further treated munofluorescence, immunohistochemistry.
with gamma-knife radiation. Another important Results: In psoriasis vulgaris TCs were particu-
aspect of the patients medical history is the total larly affected, they became dystrophic and get
thyroidectomy that has been irradiated on with lost. The dystrophy consists in apoptotic nuclei,
iodine treatment to correct the follicular thyroid nuclear extrusions, cytoplasmic disintegration
carcinoma. As a result CTs continued to be per- and fragmented telopodes (cellular prolongations
formed in order to control the hypophyseal tu- of TCs). Moreover, no homocellular junctions be-
moral rest, the echography for the examination of tween TCs were found in psoriatic skin, but there
the thyroid fossa and regular ophthalmologic and were documented contacts between apoptotic
cardiologic check-ups. TCs and dendritic cells. The basement membrane
Results: as a differential diagnosis of this in- of epidermis was interrupted in many points. Also
vestigation we have: Ectopic secretion of the GH- vascular smooth muscle cells in psoriatic dermis
RH, MEN1 syndrome. Furthermore, the objec- acquired synthetic phenotype.
tives of treatment are to control the biochemical Conclusions: In the mature lesions of psoria-
indicators of activity have a substitution for the sis vulgaris the TCs are lost and dystrophic, but
hypothyroidism and HTA treatment, preventing recovered after clearance (by topical treatment).
complications. Unlike systemic sclerosis, where the dystrophy
Conclusion: Through this report it is present- was cased by ischemia changes, in psoriasis vul-
ed the global view of an acromegaly case, study- garis the mechanism is linked to the accelerated
ing both clinical and para-clinical side. Looking keratinocyte turnover. The presented data com-
into the unique case from both anatomical, phys- plete the group of cells involved in psoriasis pa-
iological and pathological view of the case. thology. Affected TCs are presumably involved as

ABSTRACTS
trigger of the ample vascular phenomena in pso- (181) Unusual presentation

riasis. Due to psoriasis vulgaris incidence (2-8%),
the description and documentation of these new of papillary thyroid
interstitial cells can open new insights of possible carcinoma in a patient with
cellular targets.
Graves disease
(180) Predictors of Alexandra Mirica1, Rodica Petris2, Ioana
pregnancy outcomes in Cotofana1, Radu Mirica1, Sorin Paun2,
Diana Loreta Paun1
patients with systemic lupus 1
National Institute of Endocrinology C.I.Parhon,
erhytematosus Bucharest, Romania
2
Roxana Ioana Dumitriu University of Medicine and Pharmacy Carol
Davila, Bucharest, Romania Objective: Graves disease is characterized by
a thyroid gland hyperfunction due to excessive
Objective: To identify predictors of negative stimulation of the thyroid-stimulating hormone
pregnancy outcomes in patients with active sys- receptor by thyroid autoantibodies.The clinical
temic lupus erhytematosus. manifestations are specific to thyrotoxicosis (ta-
Method: Retrospective evaluation of 32 preg- chycardia, sweating, weight loss, trembling ex-
nant women with active or stable systemic lupus tremities) together with ophthalmopathy and der-
erhytematosus.The study was conducted at the mopathy. Graves disease does not prevent the
Obstetrics and Gynaecology department at the existence of an associated thyroid cancer but this
Emergency University Hospital of Bucharest. We situation rarely occurs in only 1-2% of patients.
examined the relation between the biomarkers of Methods: We present the case of a male pa-
disease activity and pregnancy outcomes. Nega- tient of 43 years old with no particular familial or
tive pregnancy outcomes were spontaneous fetal personal medical history, who presented at Na-
miscarriage, fetal loss, preterm birth, low birth tional Institute C.I.Parhon with classical signs of
weight, intrauterine growth restriction and neo- Graves disease consisting of tachycardia, sweat-
natal death. ing, trembling of the extremities and enlarged
Results: The mean age at pregnancy was thyroid gland.
28+- 4.5 years old. 30 pregnancies resulted in Results: Hormonal evaluation revealed ele-
live births. Preterm delivery occured in 32% of vated free thyroid hormones, FT4 of 25 pmol/l,
pregnancies and intrauterine growth restriction FT3 of 20 pmol/l, suppressed TSH value of 0.004
was observed in 20% of pregnancies. The miscar- microUI/ml and elevated TSH receptor autoanti-
riage rate was 13.5%. The most important predic- bodies. Thyroid ultrasound showed a heteroge-
tors of negative pregnancy outcomes were: age at neous goiter by the presence of many nodules,
pregnancy, disease activity at the onset of preg- the largest of 19/16 mm with increased vascular-
nancy, low platelet count, the presence of lupus ity without associated lymph nodes. The patient
anticoagulant, maternal flares and renal disease. was prescribed 20 mg of thiamazole daily and
Conclusion: Systemic lupus erhythematosus metoprolol 50 mg per day, obtaining the control
can determine pregnancy complications, but of the thyrotoxicosis in two months. Subsequently
pregnancy as well can cause lupus flares. In sta- the patient underwent total thyroidectomy and
ble/moderate disease or inactive disease, without histopathological examination showed a neo-
risk factors, pregnancy outcomes are favorable. plasm comprising of cells arranged in papillary
Pregnancy in lupus is a complex matter, but yet pattern. Furthermore, radioiodine therapy con-
manageable. sisting in a dose of 100 microcuries was adminis-
tered in order to prevent recurrence and to de-
stroy remnants of the thyroid tissue.The patient
evolution was favorable, with no reccurence of
Graves disease and without papillary thyroid car-
cinoma secondary determinations.
Conclusions: We present the case of a male
patient who presented with specific symptoms of
Graves disease that concealed a papillary thyroid
carcinoma, whose further development was good

ABSTRACTS
under appropriate medical, surgical and radioio- adrenalectomy. Histopathologic and immunohis-
dine treatment. tochemical examination diagnose pheochromo-
cytoma, without invasion of adjacent tissues. The
(182) Endocrine patient evolution was favorable, with the remis-
sion of the symptoms and normalization of hor-
hypertension secondary to monal markers.
pheochromocytoma Conclusions: We present the case of a young
patient who presented with specific symptoms of
Alexandra Mirica1, Ioana Anca Badarau2, pheochromocytoma, whose further development
Rodica Petris2, Ioana Cotofana1, Radu was good under appropriate medical and surgical
Mirica1, Sorin Paun2, Diana Loreta Paun1 treatment.
1
Bucharest, Romania (191) Chemotherapeutic
2
University of Medicine and Pharmacy Carol and psycho-therapeutic
interference in marginal
Objective: Pheochromocytoma is a rare neu- psychiatry
roendocrine tumor, clinical manifestation consist-
ing of the triad palpitations with tachycardia, epi-
Elena Preda, Andrei Tudor Chiriac,
sodic headache and sweating. Most phaeochro- Aureliana Boitos
mocytomas are sporadic but in approximately 30 Psychiatric Hospital Dr. Constantin Gorgos,
percent of patients the disease is a part of a ge- Bucharest, Romania
netic disorder.
Methods: We present the case of a young pa- Objective: The current trend in psychiatric
tient of 24 years old with no particular family and research to focus on neurosciences, psychobiol-
personal medical history, who presented at Na- ogy, and psychiatric pharmacology does not re-
tional Institute C.I.Parhon by transfer from Craio- duce the importance of psychotherapy that has
va County Hospital for endocrine evaluation of already proven its efficiency
hypertensive crisis with maximum of 270 mmHg The integrative pharmacological and psycho-
systolic in the presence of an adrenal tumor of therapeutic approach brings us closer than ever
48/37 mm. On admission in Craiova County Hos- to the major objective of any research: improving
pital, the patient accused headache, dizziness therapeutic strategies, disease prevention or im-
and vomiting in the context of a hypertensive cri- provement of life quality.
sis suddenly installed. Also during hospitalization Methods: Our study was extended over 12
patient had ventricular and supraventricular ex- months. The number of patients involved was of
trasystoles, controlled under treatment with biso- 178 out of the patients of the Dr Constantin
prolol, doxazosin and indapamide. The patient Gorgos -Titan Psychiatric Hospital.
was transferred to National Institute C.I.Parhon The Patients were interviewed; they have
for further investigations. been psychologically tested, especially on de-
Results: Hormonal evaluation revealed ele- pression and anxiety.The sample group of 200
vated plasmatic metanephrines (1000 pg/ml), patients of Dr Constantin Gorgos-Titan, Psychia-
plasmatic normetanephrines (1227 pg/ml) and try Hospital Outpatient Departament
serum serotonin (1190 ng/ml) with normal uri- The Working Team:
nary metanephrines and normetanephrines. Fur- Consisted in psychiatrist, psychotherapist,
thermore, plasmatic chromogranin A and neu- clinical psychologist, sociologist, art therapist and
ron-specific enolase were within normal limits. kinetic therapist.
The assessment of pituitary, thyroid, parathyroid Patients were selected to form of group psy-
hormones, aldosterone-renin axis and ACTH-cor- chotherapy psychiatry psihoeducational variety
tisol axis values were within normal limits. Ab- marginal group due to their size and psychiatric
dominal computed tomography showed expan- variety
sive left adrenal tumor of 48/37 mm with Earlier sessions of the group patients were
hypodense aspect with right adrenal gland with- trained in short sequences of individual psycho-
out modification and without regional lymph therapy like: Baruch Araujo, Barahona Fernandes,
nodes. The patient was transferred to the general Ybor Lopez. At the end of the group sessions each
surgery ward of the University Hospital Floreasca, patient participated in another session of therapy
where the surgeons practiced a laparoscopic left with one of the team members therapists. Phar-

ABSTRACTS
macological therapy consisted in timostabilizers, Imaging has an important role in initial evalu-
anxiolytics, sedative abuse. ation and follow-up of urolithiasis in infants and
Conclusion: Marginal Psychiatry gives a phe- knowing the diagnostic value of different imaging
nomenological variety so complex that the com- modalities and its limitation is mandatory in eval-
bination of processes and psychotherapeutic uation of pediatric patients.
techniques to pharmacological treatment can be
required urgently.Effective to decrease depressive (193) Therapeutic
episodes, anxiety, depression, etc., and able to
increase the efficiency of patient looming possi- difficulties in lupus
bility of reintegration, improving self-esteem, in- pericarditis a case report
tegration into family responsibilities prior illness,
increase the training of patients and information Irina-Alexandra Calangea1,
to people close on the human condition and Stefan Sebastian Busnatu2,
mental health. Crina-Julieta Sinescu1,2
1
(192) Assessment of imaging Davila, Bucharest, Romania
procedure in diagnose and 2
Department of Cardiology, Emergency
University Hospital Bagdasar-Arseni, Bucharest,
follow up of obstructive Romania
urolithiasis in infants
Objective: Systemic lupus erythematosus
Oana Rizea1, Bianca Serban2, (SLE), a connective tissue disease can affect all or-
Cristina Nicolae1, Ioana G. Lupescu1,2 gans, including the heart. All parts of the heart
1
Fundeni Clinical Institute, Bucharest, Romania can be involved, including the pericardium, the
2
University of Medicine and Pharmacy Carol myocardium, the valves, the conduction system,
Davila, Bucharest, Romania the coronary arteries. The prevalence of cardio-
vascular involvement is about 50%, with 12-48%
cases of pericarditis. The management of SLE
Objectives: The purpose of this paper is to
pericarditis can be difficult in some cases.
present the radiologic features of hydrouretero-
Methods: We present the case of a 31 yo fe-
nephrosis, to graduate imaging methods for an
male, admitted in hospital for dyspnoea and chest
initial accurate diagnosis and an appropriate fol-
pain, relieved by sitting up and leaning forward.
low-up of the children with urolithiasis.
She was diagnosticated with SLE, with severe
Methods: We review the imaging used in pe- neurologic, renal and skin manifestation, and
diatric population with hydroureteronephrosis with antiphospholipidic syndrome. The physical
(HUN) hospitalized in the last 5 years in Fundeni exam revealed: underweight, pallor, HR: 120/
Clinical Institute, taking into account that many min, BP: 115/70 mm Hg, left parasternal systolic
causes are involved. Conventional technics - plain murmur. The laboratory investigations (biological
film, ultrasound, intravenous urography +/ void- samples, ECG, Holter ECG, chest x-ray, echocar-
ing cystography or advanced - computer tomog- diography) led to the diagnosis of SLE pericarditis,
raphy +/- CT urography, magnetic resonance with pericardial fluid in large amount, with col-
urography, voiding ultrasonography. lapse of right heart cavities.
Results: Imaging has an important role in di- Results: Due to the fact that the patient had
agnosis, staging and follow up of the HN witch collapsed right cavities, we took into account
can vary from mild to severe, and may involve the pericardial drainage with all its risks. Fluid re-
kidneys function. In our study one of most com- placement, diuretic therapy cessation and specif-
mon cause of HUN was urolithiasis in addition/ ic therapy of SLE have resulted in improved echo-
without a urinary system malformation.We have cardiographic parameters and clinical status,
analyzed advantages and disadvantages of each pericardiocentesis no longer being necessary. Be-
of the radiological modalities, in order to choose cause the patient was diagnosed withantiphos-
the most convening strategy - merging low radia- pholipidic syndrome and has indication for anti-
tion exposure with its essential diagnostic value. coagulant therapy, the benefits of this treatment
Conclusions: The pediatric patient manage- in prevention of thromboembolic events was
ment (conservative or surgery) and follow up will weighed against the risk of pericardial effusion
be established depending on etiology, its grade, transforming into haemorragic pericarditis. Ulti-
additional pathology and clinical features. mately, the patient receives anticoagulant therapy
with good results.

ABSTRACTS
Conclusions: Cardio-vascular impairment in (197) The importance of

SLE is complex, can cause diagnostic and treat-
ment difficulties and requires specific manage- psychotherapy in patients
ment of the underlying disease, as well as specific with oncological diseases
cardio-vascular medication sometimes.
Elena Preda, Andrei Tudor Chiriac,
(196) Diagnostic issues in a Maria Cristina Pricop
case of STEMI and Psychiatric Hospital Dr. Constantin Gorgos,
Bucharest, Romania
pancytopenia
As far back as the Book of Job it is mentioned
Paul Vladimir Florescu, Mihaela
the idea that body health cannot be separated
Bolohan, Tiberiu Nanea, Romi Bolohan, from that of the mind.
Vasile Iliese Spinoza in his anthropological book believes
University of Medicine and Pharmacy Carol that any disorder of the body has an equivalent in
Davila, Bucharest, Romania the mind. Leibnitz speaks of a predetermined
harmony between spiritual and bodily states.
Objectives: Patients with STEMI are treated Nowadays there are well known the connec-
with primary PCI and emergency stent implanta- tions between mind and body and as soon as the
tion followed by antiplatelet therapy. Complica- knowledge in the field of psychotherapy evoluat-
tions of treatment may raise important differential ed it became a real scientific discipline..
diagnosis problems. Objectives: The evaluation of the psycho-
Methods: Patient, 60 years, former smoker therapeutic effects as associated method of the
(indicating year packages - 60), diagnosed with basic therapy on a group of patients diagnosed
right small cell lung cancer (9 months ago), on with cancer who have since depression, anxiety,
chemotherapy - 9 cures monthly with Cisplatin + restlessness, panic diagnosis.Study duration was
Etoposide. During the 9th cure the patient pres- for 1 year (March 2015 to March 2016),and the
ents typical chest pain. Resting ECG shows wide patients are still under observation.
anterior ST segment elevation AMI. Emergency Patients included in the study were surveyed
coronary angiography reveals the origin stenosis using Sifneos questionnaire selection. As working
subocclusion progeny anterior right coronary tools the following were used:
(90% stenosis of the proximal segment, 50% mid- The 17 Hamilton Depression Scale (HAMD
dle segment). The patient suffered PCI with pro- 17)
kinetic metal stent implantation on left anterior The Montgomery-Asberg Depression
descending artery (at origin) with favorable final (MADRS)
result, TIMI 3 antegrade flow. Defense Style Questionnaire (DSQ-40) -
10 days after admission, the patient developes which revealed the defence mechanisms
pancytopenia (Hb: 8.68 g/dl 7.19 g/dl, WBC: according to qualities or styles.
5000 / 1880 ml/ml; Platelets: 325 000/94 000 Psychotherapy consisted of applying individu-
ml / ml) raising problems about the etiologic al techniques followed by group sessions.
diagnosis: thrombocytopenia after heparin thera- The effective efficiency of the psychothera-
py / post treatment with clopidogrel / post cure peutic interventions proved superior in the posi-
cytostatic cisplatin + etoposide. tive evolution of the group involved, witness be-
Oncologic consult recommends continuing ing the favourable indicators as: increasing
the antiplatelet therapy (Plavix 75 mg 1 cp/day, self-esteem, quality of life, improving of the bio-
Aspirin Cardio 100 mg 1 cp/day) combined with logical labeling with 27%
full blood transfusion after which the patient has Conclusion: The study has a history of one
a favorable evolution. year. Partial results are encouraging: optimism,
Conclusions: An atypical case that raised increasing life expectancy have resulted in objec-
questions about the risk of AMI in patients diag- tive improvement of 27% of the biological mark-
nosed with cancer and chemotherapy-related ers. Statistical techniques to analyze interpreta-
side effects of cytostatics and incidence of antico- tion were used: Students test and Xi2 (since this is
agulant and antithrombotic therapy. a small sample of patients).

ABSTRACTS
(198) The aggressiveness in (199) Vasoreactivity testing

marketing communications in pulmonary hypertension
and the impact of the in children
advertising message Eliza Cinteza1, Giuseppe Santoro3,
Marinela Filofteia Hostiuc1, Gabriel Alin Nicolescu2, Cristina Filip2, Catalin
Radu1, Maria Solomon2, Victor Lorin Cirstoveanu1, Mihaela Balgradean1,2
Purcarea2 1
Emergency Childrens Hospital Marie Curie,
1
Emergency University Hospital, Bucharest, Bucharest, Romania
2
Romania University of Medicine and Pharmacy Carol
2
3
Davila, Bucharest, Romania AORN Ospedali dei Colli, 2nd University of
Naples, Italy
Objective: Promotion, a variable of the mix in
Objectives: Vasoreactivity testing in pulmo-
marketing, holds a special place in medical ser-
nary arterial hypertension (PAH) has clear indica-
vices. Advertising is a creative activity and is a
tions concerning patients with idiopathic or he-
bridge between manufacturer, distributor and
reditary form of PAH or PAH associated with the
consumer and seeks to influence and determine
usage of anorexigen drugs in order to identify
attitudes and behaviors.
patients who can be treated with high doses of
Advertising uses the following media outlets:
calcium channels blockers. Another recommen-
television, radio, magazines, newspapers, bill-
dation for vasoreactivity testing is PAH associated
boards, posters and prints placed outside such as
with congenital heart disease in which the pa-
catalogs, leaflets, brochures, and flyers. tients are in the gray stage. In this last situation
Method: A retrospective study in which were the vasoreactivity must be tested to find a strate-
included 52 people who responded to a ques- gy: operability or Bosentan therapy for 6-12 mon-
tionnaire consisting of nine questions, distributed ths period followed by another vasoreactivity
over a period of one month. The questionnaire evaluation.
has three demographic variables and six ques- Method: Between 2015 (June) - 2016 (March)
tions related to importance and impact of the ad- in the Angiography Laboratory of Emergency
vertising messages. Demographic variables are: Childrens Hospital Marie Curie there were per-
age, education, and marital status. formed 62 diagnostic/therapeutic interventional
Results: In the study 36 people were aged be- procedures.
tween 18-25 years, 28 had university study and Results: Of the 62 patients investigated, six
39 people are unmarried. had PAH (9.7%). Of these, 5/6 had PAH associ-
Most people participating in the survey (27) ated with congenital heart disease (2 patients
said that they received promotional messages two with patent ductus arteriosus (PDA), a patient
five per month. with ventricular septal defect (VSD), one with
Only 32 of the 46 people mentioned that they atrioventricular septal defect and another one
sometimes read these materials. had two defects: PDA and VSD). One patient
23 people have stated that sometimes threw (1/6) presented idiopathic PAH. The pulmonary
some bills along with promotional materials. vasoreactivity testing was carried out in 5/6 pa-
32 people consider this promotional method tients (83%) using nitric oxide, 24 ppm. We dis-
useless. 29 people take count rarely of these pro- covered the mean pulmonary arterial pressure
motional materials in their purchasing decisions. (mPAP) 48-120 mmHg (media 80.8 mmHg). The
25 people mentioned that sometimes they are basal total pulmonary vascular resistances (TPVR)
interested in the content of these materials. were 0.71-35 WU/m2 (media 14.3 WU/m2) with
Conclusions: Promotion in marketing is a set 2/5 patients having normal pulmonary resistanc-
of tools that organizations can use to give custom- es. The vasoreactivity testing showed a decrease
ers a clear, consistent, compelling and honest in pulmonary pressures and resistances in 4/5 pa-
message. This can be used to inform about their tients; mPAP 41-100 mmHg (media 71.4 mmHg),
activities, products, education campaign and so- and TPVR 0.12-24 WU/m2 (media 8.9 WU/m2).
cial and environmental awareness. This will give Therapeutic consequences of this assessment
an advantage to the organization over their com- were: 4/5 patients had surgical/interventional
petitors, by designing in the customers mind an consequences: 1 patient suffered/1 in program
image of organization. for heart surgery, 1 patient had interventional clo-

ABSTRACTS
sure, 1 patient had step by step approach, with Conclusions: The occurrence of severe car-
partial interventional closure of PDA, then con- diac complications due to the rheumatological
tinuing with sildenafil therapy to establish the ap- disease, determined the discussion of cardiac
propriateness of cardiac surgery. In another pa- tamponade etiology. The differential diagnoses
tient the Sildenafil therapy was not tolerated, and will include: paraneoplastic syndrome, specific
the patient remained in natural history. infections (tuberculosis, Staphilococus aureus)
Conclusion: Diagnostic catheterization and and non specific infections (viral), and the pericar-
vasoreactivity testing are extremely useful in pa- dial changes within collagen disease. The anato-
tients with PAH comprehensive assessment and mo-pathologic result of the biopsy rules out the
can help for the therapy management. etiology for tumor and infections, showing only
inflammatoryprocess.
(209) Scleroderma The variety of clinical manifestations and the
different evolution in each patient, requires an
pericardial disease individualized approach of the visceral damages.
presented with large
pericardial effusion (212) Endothelial
Andreea Zoican, Alina Burcuta dysfunction particularities
in a lot of patients with
Davila, Bucharest, Romania active acromegaly
Objectives: Systemic sclerosis is a multiorgan-
Alina Maria Dumitru, Georgiana Taujan,
ic disease of the connective tissue with unknown Ruxandra Hristea, Maria Olaru, Adina
etiology, characterized by a high rate of mortality. Ghemigean, Diana Paun, Constantin
The complex pathogenesis involves simultane- Dumitrache, Adina Simona Dragomir
ously vascular lesions, the activation of the im-
mune system and generalized fibrosis. The cardi- National Institute of Endocrinology CI Parhon,
ac damage in scleroderma can be detected cli- Bucharest, Romania
nically only in 15-25% of the pacients, but in
anatomo-pathologic examination the percentage Objectives: Active acromegaly is associated
rises at 50%. The cardiac injury involves myocar- with increased cardiovascular morbidity and
dial fibrosis, ischemic disorders, pericardial effu- mortality, cardiovascular disease being the first
sions (15-43%), rhythm disturbances and less of- cause of mortality in such patients. We aimed to
ten myocarditis. Although the pericardium is assess some particularities regarding endothelial
frequently affected by inflammation and fibrosis, dysfunction in a lot of patients with active acro-
cardiac tamponade is extremely rare, leading to megaly.
important hemodynamic changes, emphasizing Methods: Cross-sectional study including 56
the diagnosis often at autopsy. patients with acromegaly (36 females, 53,4+/-11
Methods: We report the case of a 48 years years and 20 males, 44,9+/-15,5 years) referred
old female pacient with sequelae of polio, history to CI Parhon National Institute of Endocrinology.
of ductal breast carcinoma, operated, treated by IGF1, nadir GH during 75 g glucose OGTT, major
chemo and radiotherapy in 2007, diagnosed with cardiovascular risk factors and endothelial dys-
limited cutaneous systemic sclerosis form in Oc- function determined by ultrasound assessment of
tober 2015( ANA+, sclerodactyly, Raynaud syn- endothelial dependent flow mediated vasodilata-
drome, digital ulcers, gastro esophageal reflux tion of brachial artery (FMD<10%) were evalu-
disease), admitted in January 2016 to Sf. Maria ated in all our patients.
clinic, for dyspnea with orthopnea, nonproduc- Results: The prevalence of endothelial dys-
tive cough and Raynauds phenomena, progres- function in the acromegalic patients was 60,7%
sive symptoms exacerbated in the last 2 weeks. (53% in women and 75% in men). We found a
Clinical data, laboratory and imaging explorations positive correlation regarding diastolic blood
have shown massive pericardial effusion with a pressure, dyslipidemia, insulinemia and HOMA
tendency to cardiac tamponade, for which it has Index, but no correlation with diabetes mellitus,
been performed a pericardiocentesis and pericar- cholesterol fractions or triglyceride levels or hy-
dial biopsy in order to establish the etiology.The pertension. Increased GH/IGF1 levels induce the
pulmonary radiography revealed left pleural fluid, endothelium impair so this must be the reason for
drained through thoracocentesis the indirect correlation we found between GH

ABSTRACTS
level and endothelial dysfunction and also the with AD. MedCalc software, version 16.2.0, was
positive correlation with the time of evolution of used for analysis.
the disease. Results: The adjustment model comprised
Conclusions: Endothelial dysfunction is more smoking (OR = 0.23 p = 0.02) and trimester of
frequent in patients with acromegaly as we found antibiotic administration during pregnancy (OR
in literature and this test can be used as an addi- = 1.7 p = 0.01). In simple logistic regression sol-
tional risk factor for cardiovascular events and id food introduction over 6 months (OR6-months
also can be used to evaluate the response to treat- = 8.94, p = 0.0003) and at 4 to 6 month (OR4-6
ment. The correlation between GH level and en- months = 2.69, p = 0.02) was associated with
dothelial dysfunction may lead to the conclusion AD. After adjustment for the above described
that we can use the GH as a predictor for cardio- model only diversification over 6 months was in-
vascular events. dependently associated with AD (OR6-months =
12.4; p = 0.004 and OR4-6 months = 1.7; p =
(213) Late introduction of 0.34).
Conclusion: Delayed introduction of solids
solid food in children over 6 months of life was associated with an in-
increases the risk of atopic creased risk of AD.
dermatitis
(215) Genetics bridges
Larisa Simon, Ana-Brigitta Giuca,
specialities that medical
Mihaela Panduru
students learn
Davila, Bucharest, Romania Rodica Mirela Dragotoiu, Gabriela
Loredana Popa, Loredana Manolescu,
Objectives: Atopic dermatitis (AD) is a chron- Madalina Preda, Silvana Adelina
ic inflammatory skin disease that has an increas-
ing prevalence. It is the first manifestation of the
Gheorghe, Mircea Ioan Popa
atopic march preceding respiratory allergy and it University of Medicine and Pharmacy Carol
appears in genetically predisposed individuals. Davila, Bucharest, Romania
Environmental factors are also involved in the dis-
ease occurrence. The aim of the study was to in- Objectives: Teaching genetics to medical stu-
vestigate the moment of solid food introduction dents proves to be challenging in a time of great
and AD. upheaval caused by discoveries made every day
Method: We performed an observational in this field. Besides, genetics usually entails im-
study on 190 subjects presented to the derma- portant knowledge for medicine and this is
tologists office. The parents filled a questionnaire spreading not only among scientists, but also
divided in two parts. The first part contained the through public media, raising peoples awareness
main three questions from International Study of concerning inherited traits. Some of the challeng-
Asthma and Allergies in Childhood survey for the es are represented by choosing the amount and
AD diagnosis while the second part comprised type of information that students should receive
questions regarding the factors that could be in- during their one term training in medical genet-
volved in disease occurrence. All the subjects ics, this being the necessary basic knowledge they
were consulted by dermatologist and AD diagno- should gain to help them in their future studies
sis was made according to U.K. Working Partys and practice.
Diagnostic Criteria. The objective of this study is to demonstrate
All potential variables associated with AD the usefulness of the genetic knowledge acquired
were tested at first by binary logistic regression. during the first year by medical students.
All possible risk (p 0.05) or confounding factors Method: Questionnaires were answered by
(p 0.10) associated with AD in simple logistic second year students of the Medical and Phar-
regression were then introduced in a multiple lo- macy University Carol Davila after they learned
gistic regression with stepwise selection of covari- about the genetic features of microbes. 377 stu-
ates. Variables retained in this model represented dents answered 3 questions concerning the use-
the adjustment model. Finally, the moment of fulness of the information (overall, during the lec-
solid food introduction was introduced in a logis- tures and then during the workshops) learned in
tic regression adjusted for the above described medical genetics for understanding the microbial
model in order to test its independent association genetics. A 4th question asked them to specify

ABSTRACTS
how useful was the knowledge gained in genetics For 307 patients, included in the group, p16/ Ki-
during high school. 67 immunocytochemical testing was negative,
Results: The data obtained show that lectures and for the rest 244 patients tested the immuno-
and workshops of medical genetics are further cytochemical staining turned out positive.
helping students in their training. Only 19.10% of Conclusions: The use of p16 / Ki-67 immu-
students considered that what they learned in nocytochemical tests optimizes the medical ap-
medical genetics during the practical workshops proach in screening or surveillance of young pa-
was not at all useful, as also considered 18.04% of tients with high-risk positive HPV LSIL or ASC-US
them the knowledge gained in the lectures of the cytologic results, enables avoiding unnecessary
same specialty. In the paper we discuss the in- colposcopy (indications for colposcopy are re-
sights generated by the students answers, and by stricted to positive CINtec PLUS cases), thereby
their specific observations noted after completing limiting the invasive gestures on nulliparous. Neg-
the questionnaire, and we analyze the limitations ative CINtec PLUS results are subject to cytologic
and biases of the study. and viral surveillance at every 12 months.
Conclusion: The present curriculum in medi-
cal genetics helps students understand and learn (224) Herpes infections in
the knowledge on the genetics of bacteria and
other types of microbes. With both fields, medi- HIV infected patients from
cal genetics and microbiology, extending in the Giurgiu county
last years due to new discoveries, a better inter-
disciplinary alignment of the information taught Loredana Manolescu, Paul Marinescu
would undoubtedly benefit students. University of Medicine and Pharmacy Carol
(223) Role of
Objective: HIV infected patients have differ-
immunocytochemical ent opportunistic infections as they came across
markers in cervical different patogens. Herpes viruses are widely
precancer risk assessment spread in general population and put no risk on
immunocompetent person. In HIV infected even
Alexandru Baros1, Mihaela Badea2, a simple recurrence with HSV1 may cause dra-
Roxana Bohiltea2,3, Monica Cirstoiu1,2 matic simptomatology. The objective was to as-
1
sess the prevalence of HSV infections in HIV in-
University of Medicine and Pharmacy Carol fected from Giurgiu County and also the number
Davila, Bucharest, Romania of HSV recurrences over a period of one year.
2
Department of Obstetrics-Gynecology, Method: 213 HIV infected patients were
Emergency University Hospital, Bucharest, monitored over a period of one year. They were
Romania clinical and paraclinical investigated. For HSV di-
3
MICOMI Clinic, Bucharest, Romania agnosis direct and serological tests were per-
formed. Direct detection and identification of
Objective: Highlighting the effectiveness of HSV-1 and HSV-2 was performed directly on the
p16/ Ki-67 dual-stained cytology that combines specimens with HSV1/2 Typing DFA Kit. To en-
high sensitivity with high specificity, a solution sure specificity culture isolation was performed
that has been developed in recent years to in- by standard tube culture isolation procedure.
crease cervical precancer detection. The test is a Results: The group of studied patients is long
dual-stained cytology performed simultaneously survivors born during 1987-1994. They were
in the same cell for p16 - transforming infection monitored over a period of one year. The average
marker and Ki67 proliferation marker, from cer- number of CD4 were 438.3 cells/ml and average
vical cytology samples. HIV viral load was 144 912.3 copies RNA/ml.
Method: Assessment of a group of 551 pa- 110 patients presented Herpes zoster, out of
tients aged 19-72 years, in terms of clinical use- them 12 had at least two recurrences. 46 present-
fulness of immunocytochemical markers. ed atypical HSV infections and 5 of them had at
Results: The exclusion criteria applied were least two recurrences. Only 31 out of 213 HIV
high-grade lesions cytologies, absence of histori- infected were not HSV 1 infected. During one
cal and clinical data, and absence of HPV analy- year, the HSV1 infected presented 459 recur-
sis. Referrals for CINtec PLUS test were triggered rences; the maximum number of recurrences en-
by ASC-US and L-SIL cytology <30 years, nega- countered in one person was 6. Three patients
tive cytology/ positive HPV test regardless of age. presented infections with HSV2 and had only one

ABSTRACTS
recurrence over the year of monitorisation. 17 Conclusions: In spite of the positive develop-
patients had chickenpox that year. All patients ment, photoreceptors layer loss is seen on OCT,
were treated with different forms of acyclovir. which explains the fact that there is no improve-
Conclusion: Herpes infections are very comment in the visual acuity of the patient.
mon in HIV infected patients and all patients pre- It is very important to mention that the relapse
sented herpes infections. The most prevalent was of the CSCR on the right eye is a particularity of
HSV1, followed closely by VVZ. During the peri- the case, because it is known that the patients in
od of study despite the etiological treatment the which the visual acuity does not show an im-
recurrences were frequent. The frequency of re- provement after the treatment are more likely to
currences was closely linked with the immune suffer from a relapse of the disease on the same
and viral status of HIV infection. eye, not on the congener one.
(225) A curious case of (226) Thrombophilia and

central serous pregnancy screening of
chorioretinopathy pregnant women admitted
Irina-Mihaela Anghel, Mariam Tarhini, to Emergency University
Madalina Petre Hospital
University of Medicine and Pharmacy Carol Diana Voicu1,2, Roxana Bohiltea1,2, Oana
Davila, Bucharest, Romania Bodean1,2, Octavian Munteanu1,2, Radu
Objective: We present a case of reccurent
Gabriel2, Radu Eugen2, Elvira Bratila1,2,
CSCR in a male patient, at the age of 35 years old. Costin Berceanu2, Claudia Mehedint2,
He presented himself to the outpatient depart- Liana Ples2, Anda Baicus2, Irina
ment of a private medical facility, accusing de- Horhoianu3, Monica Cirstoiu1,2
creased visual acuity (VOD) in the right eye with 1
an onset of about 1-2 weeks, as well as metamor- Department of Obstetrics and Gynecology III,
phosia. His medical fiels reveal that he has a his- Emergency University Hospital, Bucharest,
tory of central serous chorioretinitis (CSCR) in the Romania
2
left eye diagnosed in 2014. University of Medicine and Pharmacy Carol
Method: Following doctors examination, the Davila, Bucharest, Romania
3
patient underwent a series of medical investiga- University of Medicine and Farmacy, Craiova,
tions, as it follows: measurement of the intraocu- Romania
lar pressure, investigation of the optical axis, eye
Objectives: Thrombophilia is a disorder char-
fundus examination and an optical coherence
acterized by blood hypercoagulability occurring
tompgraphy (OCT) for both eyes, as a method of
as a result of hereditary or acquired predisposi-
assessing subretinal fluid and macular changes.
tion substrate and depends on changes that occur
There was requested an assesment of the visual
regarding the balance of coagulation and hemo-
acuity and a microbiolgical investigation to detect
stasis.
a possible infection with Helicobacter pylori, a
The aim of this study was diagnosis of preg-
bacteria which could be associated with the de-
nant women suspected of thrombophilia due to
velopment of CSCR.
medical history and family history.
Results: Investigations have found that the
Methods: Between September 15th 2015 and
patient has an IOP of 14 mmHg, and a normal December 31st 2015, the researchers enrolled
optical axis. Right eye fundus examination shows 636 pregnant women with average age 29.5
a slightly nonhomogeneous macula, otherwise years. The diagnostic methods included clinical
normal, whilst for the left eye it shows pigment exam, pregnancy test or abdominal transvaginal
epithelial detachments, RPE atrophy, subretinal ultrasound at all patients included in the study.
fibrin, chronic CSCR and macular edema and Laboratory samples included protein C, protein S,
neurosensory macular detachments. antithrombin III, homocysteine, lupus anticoagu-
For the right eye, the OCT shows neurosen- lant, LA ratio, PRCA. Genetic analysis collected
sory retinal detachment, subretinal fluid with fo- during the study included mutations of factor V
veal fotoreceptors layer preserved. and gene MTHFR, mutation of factor XIII, poly-
The results of the microbiological investigation morphism mutation of PAI and EPCR gene muta-
are still awaited. tions.

ABSTRACTS
Results: Of the 636 patients included in value HOMA-IR=2, or possible insulin resistance,
screening, a total of 412 patients (64.77%) had we found that 40.23% of our patients exhibited
history of repeated miscarriages (more than two), such a characteristic, it being much more preva-
421 (66.19%) were smokers, 353 (55.5%) had lent in the male portion. Of the individuals with
used oral contraceptives more than 5 years, and higher HOMA-IR, an equal EDSS score distribu-
198(31.13%) had family history of thrombosis. tion of 1.5-2,5 was observed in both genders.
Conclusion: Most pregnant women included Conclusions: From our partial results, we
in the study had a history of recurrent miscarriag- have been able to correlate the low vitamin D
es or thrombotic events, being known that these status and the severity of multiple sclerosis. Insu-
factors suggest an incresed risk of hypercoagula- lin resistance however does not have sufficient
ble state in pregnancy. evidence to properly link it to multiple sclerosis.
(230) Clinical and metabolic (234) Bilateral occlusion of

associations in multiple the inferior cerebral
sclerosis arteries in a patient who
Mihai-Bogdan Ioncea, Ovidiu Bajenaru suffered a minor ischemic
University of Medicine and Pharmacy Carol stroke case presentation
Davila, Bucharest, Romania Mihaela Micu1, C.F. Plesa2,
Objectives: The numerous physical and psy-
M.A. Stanciuc3
1
chological effects of multiple sclerosis are well INNBN, Bucharest, Romania
2
documented. However little is known of the University of Medicine and Pharmacy Carol
mechanisms by which this illness manifests or is Davila, Bucharest, Romania
3
aggravated. For this reason a great deal of interest Military Central Hospital, Bucharest, Romania
has been given to vitamin D status of the body
and insulin resistance, which are closely linked to We present the case of a 59-year old patient,
MS. smoker and drinker, who is known with arterial
Method: A cohort of 87 people suffering of hypertension, type 2 diabetes and glaucoma of
multiple sclerosis, of which 56 females and 31 the left eye. He presented to the emergency room
males, have been investigated for possible meta- for dysarthria and a confusional episode, which
bolic correlations with multiple sclerosis. The pa- started the day before admission.
rameters of interest in this study are vitamin D Clinical and neurological examination high-
serum levels and HOMA-IR, these being com- light: AT = 140/80 mmHg, VA = 70/min, rhyth-
pared with the EDSS score and other neurological mic, no neck stiffness, lateral left homonymous
tests. hemianopia, left hemiparesis 4/5 MRC, globally
Results: The first observation has been the diminished OTR, Babinski sign present on the
gender distribution of our cohort, favoring the fe- left, left hemihypoesthesia, left hemicrania.
male gender, which is characteristic of the dis- Laboratory tests were normal, except for a
ease. The mean age of the female portion is 38 blood glucose of 185 mg/dl. EKG: sinus rhythm.
years, and that of the male portion is 36 years. Cerebral CT exam diagnosed a recent isch-
Although fewer in number, the male portion pre- emic stroke in the territory of the left MCA. The
sented a higher percentage of individuals under cervical and cerebral Doppler highlights severe
the average age. The second observation was bilateral carotid atheroma, with a bilateral occlu-
linked to vitamin D serum levels. With the results sion of the ICA. TheAngio-CT scan confirmed bi-
being between 8 and 50 ng/ml, and a mean con- lateral occlusion of the ICA.
centration of 24,92 ng/ml, out of the 87 partici- The diagnosis of acute ischemic stroke in the
pants, 73% were deemed vitamin D deficient at superficial territory of the left MCA with left hemi-
the time of the investigation. To put that into per- paresis, bilateral occlusion of the ICA, severe bi-
lateral carotid atheroma was established. The
spective, we matched our patients vitamin D lev-
treatment was performed through admission of
els with their respective EDSS scores and found
drugs (platelet antiaggregant, anticoagulant, lipid-
that the vast majority of individuals with high
lowering-statin), the occlusion of the carotid hav-
EDSS scores presented low levels of vitamin D.
ing no indication of angioplasty. We also adminis-
The last parameter utilized has HOMA-IR, used
tered treatment for the chronic associated pa-
to determine insulin resistance. Using as a cut-off
thologies (oral antidiabetic, antihypertensive, gas-

ABSTRACTS
troprotection) along with maintaining a normal ODI for the 3% and 4% cut-off values for the in-
blood pressure in order to allow a good brain vas- dependent desaturation was calculated. The cor-
cularization. The evolution was favorable, with relation between ODI3%, ODI4% and AHI was
the improvement of the neurological deficits. assessed.
The particularity of the case: Results: 97 patients (58 males) were enrolled
1. Although the occlusion of the ICA was bilat- in the study, with a mean age of 50.811.8 years,
eral, the stroke was located in the superficial ter- a median BMI of 43,2 kg/m2 (40-67.5), a median
ritory of the left MCA, not in the border territory AHI of 44/hour (8-131), a median ODI3% 45/
as we would expect with the MCA-PCA being the hour (2-139), a median ODI4%: 33.5/hour (1.8-
area where strokes occur more frequently and 128), a median average SaO2: 90% (49-96) and a
more specifically in case of severe carotid athero- median lowest SaO2: 71% (39-91). A statistically
ma. significant positive correlation between ODI3%
2. Although it was a bilateral occlusion, the (r=0.85, p<0.001), ODI4% (r: 0.82, p<0,001)
occlusion of the left ICA remained asymptomatic. and AHI was found.
3. The neurological deficit was minor com- Conclusion: In morbidly obese patients with
pared to the severity of the atheroma, suggesting OSA, ODI calculated by both cut-off values for
proper functioning of the posterior vascular terri- the independent desaturation, correlate with AHI
tory with an effective alternate circulation devel- determined by cardio-respiratory polygraphy.
oped over time.
(237) The Dash diet need
(236) Apnea hypopnea index for databases of minerals
and different cut-off values and poliphenolic
for defining Oxygen concentrations in foods
Desaturation Index and in literature survey
patients with morbid
Adriana Mihaela Tudose1, Nicolae Viorel
obesity Dumitrescu2, Petrisor Eduard
Stefan Dumitrache-Rujinski, Ionela Adamescu2, Liliana Tudoreanu3,
Erhan, Carmen Stroescu, Ionela Butuc- Carmen Gabriela Dobjanschi1
Andreescu, Alexandru Cocieru, 1
Alexandru Muntean, Simona Merisor, Davila, Bucharest, Romania
2
Bianca Paraschiv, Dragos Zaharia, Miron Clinical Hospital N. Malaxa, Bucharest,
Bogdan Romania
3
USAMV of Bucharest, Romania
Davila, Bucharest, Romania The DASH diet (Dietary Approaches to Stop
Institute of Pulmonology Marius Nasta, Hypertension) was ranked as the Best Overall
Bucharest, Romania Diet by US News & World Reports in 2011,
2012, and 2013. Its potential to influence allergic
Background: Basal nocturnal oxyhaemoglo- immune reactions was not sufficiently tested. The
bin level (SaO2) in patients with morbid obesity is DASH diet includes whole grain, fruits and veger-
usually low due to alveolar hypoventilation. The ables for 1600- 3100 calorie diets. Whole grain
Oxygen Desaturation Index (ODI) calculated cereals are good sources of phenolic compounds
with different cut-off values for the independent and amino phenolic compounds. The nutritional
desaturation may differ from the Apnea Hypop- composition of whole and refined wheat flour
nea Index (AHI, determined by cardio-respiratory differs markedly and studies indicate that through
polygraphy) in assessing Obstructive Sleep Apnea refining process, most of the bran and some of
(OSA) severity. the germ are removed, resulting in loss of dietary
Objective: To assess the correlation between fiber, vitamins, minerals, lignans, phytoestrogens,
ODI3%, ODI4% and AHI in patients with morbid phenolic compounds, and phytic acid therefore
obesity. all processing techniques will involve a change in
Methods: We prospectively evaluated mor- all nutrients and bioactives availability as well as
bidly obese (BMI >40 kg/m2) patients with OSA general nutritional quality changes. Self-reported
(cardio-respiratory polygraphy, AHI >5/hour). survey data in the United States suggest that there

ABSTRACTS
was an increase of 18% in food or digestive aller- Methods: In our study, we performed muta-
gies from 1997 to 2007. The influence of poli- tion screening for GJB2 in 42 non-syndromic
phenolic content of foods may also influence al- hearing loss families, including those with cases of
lergic immune reactions. USDA published an sporadic deafness. Peripheral blood lymphocyte
updated database on bioactives in foods, such as DNA was used to amplify by polymerase chain
the USDA Database for the Flavonoids Content of reaction the Cx26 coding region, followed by
Selected Foods. These databases are helpful in 35delG mutation detection screening and com-
calculating the daily poliphenolic intake of US plete sequencing. For DNA extraction we used
population based on population diet patterns. QIAamp DNA Blood (QIAGEN), and PCR frag-
However usual databases for foods composition ments were sequenced using the forward primer
do not highlight limiting factors for food con- and the ABI BigDye Terminator v3.1 Cycle Se-
sumption in the case of allergies. We believe that quencing Kit.
such data will be of great importance as many of Results: The most frequent mutation was
the foods which are rich in polyphenols may con- 35delG. The study of allele frequency 35delG
tain also non-specific lipid transfer proteins showed a significant association between the
(nsLTPs) which are known to be panallergens and presence of 35delG allele and extent of damage
believed to account for the majority of LTP allergy (2 = 20.573 / p = 0.0001 for profound hearing
(pollen-food syndrome). Moreover the textural loss; 2 = 6.759 / p = 0.0093 for severe hearing
properties of processed and raw foods will influ- loss; 2 = 1.689 / p = 0.1937 for moderate hear-
ence minerals and bioactives availability. Our lit- ing loss to those with mild hearing loss).
erature survey suggest the need of diet inquiry Conclusions: The high prevalence of the
standardization and also need for including in 35delG mutation may justify its use in screening
food databases a larger selection of minerals and for severity of hearing impairment.
poliphenolic concentrations for processed and The mutational screening in this gene may be
raw foods. Also we suggest that questions on tex- effective and beneficial for diagnosing hearing
tural properties of foods should be included in loss in population.
the diet inquiries in order to better understand
nutrients and bioactives bioavailability as influ- (240) New drug delivery
enced by texture and consumers preference.
model in ischemic pathology
(239) Impact of GJB2 Iurie Roatesi
mutations in children with University of Medicine and Pharmacy Carol
non-syndromic hearing loss Davila, Bucharest, Romania
Cristian Razvan Strugaru, Roxana Objective: Tissue loss and organ dysfunction
Bohiltea, Adela Elena Brinzan, Cristian due to hypoxia is a major factor involved in isch-
Constantin Popa, Radu Ioan Ursu, emic pathology. Thus, for example improving the
anti-hypoxia therapies of cardiomyocytes has
Laurentiu Camil Bohiltea been an important issue within the cardiovascular
University of Medicine and Pharmacy Carol field. Microenviorment of hypoxic area modifies
Davila, Bucharest, Romania celluar metabolism including overexpresseon and
upregulation of LDL-receptor (LDL-R) that en-
Background and aims: Non-syndromic hear- hances Low Density Lipoprotein (LDL) endocy-
ing loss is the most common sensory deficit in hu- totic rate. This model take advatage of naturaly
mans, with profound medical, social, and cultural occured LDL endocytotisis to introduce ApoB-
ramifications. For the children born with moder- 100 functionalized liposomes (ApoB100-L) load-
ate to profound hearing impairment, particularly ed with active biomolecules to block pathways
in families in which there is no previous history of involved in hipoxia related cell changes. This mo-
deafness, the diagnosis has a major impact on del was tested and validated using in-vitro studies
that family. on cultured cells that have overexpressed and in-
Objectives: Testing for mutations in GJB2, the creased LDL endocytotic rate.
gene for connexin 26 (Cx26) that can account for Methods: Liposomes were prepared usind
up to 60% of prelingual nonsyndromic hearing rotary-evaporator method, from a lipid stock so-
impairment, is commercially available, and many lution containing: phospholipids, cholesterol and
more deafness-related genetic tests undoubtedly fluorescent dye. For ApoB100 containing sample,
will follow in the near future. the protein was dissolved in methanol and then

ABSTRACTS
mixed with lipid solution. Two samples were Methods: We retrospectively studied 103 pa-
made one containing simple liposomes and other tients admitted in the Infectious and Tropical Dis-
containing ApoB-100 functionalized liposomes. ease Hospital Dr. Victor Babes with the diagno-
Circular dichroism (CD) analysis of ApoB100 sis of infective endocarditis between October
sample was used to estimate protein secondary 2014 and September 2015. We excluded from
structure. The samples were incubated with A375 the study 18 patients with incomplete data and
humman cells for 2 and 4 hours. After this period their further readmissions in this period. The pa-
the medium was removed and cells were washed tients age ranged between 31 and 89 years old.
with PBS. Transmission and fruorescence micros- For the remaining 85 patients we analyzed the
copy were used to examine liposomes endocyto- etiology of the infective endocarditis and the an-
sis and intracellular distribution. tibiotic susceptibility of the identified germs. We
Results: The state of ApoB100 protein was used Epi Info 7.1.5.2.
analysed, CD data shows the presence of a mini- Results: Of the 85 blood cultures, 36 were
mum at 220-230 nm. This confirms that the prep- negative. The most frequent etiology was repre-
aration protocol leaves the protein biding active sented by Staphylococcus spp., 22 isolates in 21
site unperturbed with -helical secondary struc- patients; this germ was also involved in polimi-
ture conformation conserved. So these liposomes crobial etiology. The species of this genus identi-
are capable for docking, binding to the LDL-R fied in this study were Staphylococcus aureus (in
and direct receptor activation of cellular endocy- 10 blood cultures, of which 6 were methicillin-
tosis. Fluoresence microscopy images demonstate resistant), Staphylococcus epidermidis (3 cases,
that ApoB100-L were distributed in the cell with 95%CI: 0.73%-9.97%), and other species of co-
the same pattern as a positive control using la- agulase-negative Staphylococcus (9 cases). The
beled humman LDL. next genus in order of the frequency was Strepto-
Conclusion: Specific interactions between coccus spp., isolated in 16 cases, mainly repre-
ApoB-100 functionalized liposomes and over- sented by Streptococcus gallolyticus (7 cases,
expressed LDL-R can be used to target hipoxic 95%CI: 3.38%-16.23%). Other identified germs
areas without causing harm to normal tissues. were Enterococcus spp., Candida spp., Coryne-
Feature of molecular therapies must be investi- bacterium spp., Serratia spp., Klebsiella spp. and
gated, in situations where there are no options, or others. Of the isolated species, 16 were resistant
when these conventional methods have limita- to erythromycin (95%CI: 11.16%-28.76%), 16 to
tions. This work opens up new avenues for devel- tetracycline (95%CI: 11.16%-28.76%), 11 to
oping targeted drug delivery treatment for bene- methicillin, 11 to penicillin, 11 to oxacillin
fits in ischemic heart disease. (95%CI: 6.64%-21.98%), 10 to ciprofloxacin
(95%CI: 5.79%-20.57%), 9 to ampicillin (95%CI:
(245) Infective endocarditis, 4.96%-19.15%), 8 to rifampicin (95%CI: 4.15%-
17.71%), 7 to clindamycin and 7 to gentamycin
isolated germs and their (95%CI: 3.38%-16.23%).
susceptibility to antibiotics Conclusions: A few decades ago the most fre-
quent identified germ in infective endocarditis
Madalina Preda1, Maria Nica1, was Streptococcus spp. In this study the etiology
Silvana-Adelina Gheorghe1, Gabriela- involved Staphylococcus spp., followed by Strep-
Loredana Popa1, Mircea-Ioan Popa1, tococcus spp., Enterococcus spp. and other or-
ganisms. Most often, the isolated germs were re-
Emanoil Ceausu2
sistant to erythromycin, tetracycline, methicillin,
1
University of Medicine and Pharmacy Carol penicillin and oxacillin.
2
Hospital of Infectious and Tropical Diseases
Victor Babes, Bucharest, Romania
Objective: An important aspect in the treat-

ment of infective endocarditis is to choose the
right antibiotic to which the isolated germ is sus-
ceptible. We conducted this study in order to de-
termine the most frequent germs involved in the
etiology of infective endocarditis and their sus-
ceptibility to antibiotics.

ABSTRACTS
(247) Digital acute ischemia tial causes. The patient presented combines all
these risk factors.
on a young patient with
systemic lupus (248) Complications of
erythematosus surgical approach and cure
Catalina Ana Maria Buta1, Sanziana rate in patients with
Daia-Iliescu1, Laura Groseanu2, Daniela craniopharyngioma
Opris2, Ruxandra Ionescu2
1
Adela Ghinea1, Elena Iuliana Stanica2,
Department of Internal Medicine and
Cristina Capatina2, Anda Dumitrascu1,
Rheumatology, Clinic Hospital Sf. Maria,
Bucharest, Romania Catalina Poiana1,2
2
National Institute of Endocrinology C.I Parhon,
Davila, Bucharest, Romania Bucharest, Romania
2
Objectives: We present the case of a 34-year- Davila, Bucharest, Romania
old patient, diagnosed in 2004 with SLE (systemic
lupus erythematosus) with multiple organ in- Objective: We analyzed the surgical result
volvement (skin, joints, kidneys, serous and hae- and complications after surgery in patients with
matological) and secondary antiphospholipid craniopharyngioma followed-up in the pituitary
syndrome, followed in the Internal Medicine and and neuroendocrine diseases department and
Rheumatology Clinic of St. Mary Clinical Hospital pediatric endocrinology department at the Na-
Bucharest. The patient presents in February 2016 tional Institute of Endocrinology C.I. Parhon Bu-
for acute pain and cyanosis of the second and charest.
third finger of the right hand witch appeared Method: This is a retrospective study of surgi-
three days ago. cally treated craniopharyngioma patients, fol-
Methods: The onset of the disease was after a lowed-up in a tertiary center of endocrinology.
miscarriage (2002) when antiphospholipid syn- The study group consisted of 82 patients, 21 un-
drome was diagnosed; in time developping renal der 18 years of age (25.61%) and 61 between 18-
(membranous GN and proteinuria+++) and 72 years (74.39%).
haematological involvement (leukopenia). Immu- Results. The most commonly used surgical ap-
nosuppressive therapy with Cyclophosphamide proach in adults was the transfrontal one, used in
(6 cycles), then Hidroxicloroquin and high doses 38(62.29%) patients. Excision was complete for
of corticosteroids was initiated and the patient 20(32.78%) and incomplete for the remaining
enters remission until 2015. In April 2015 the de- 41(67.21%) patients. Pituitary function was nor-
sease flares after a cutaneous infection (retinal mal in 24 adult patients (39.34%) and 4 children
vasculitis, intensifying Raynauds phenomenon, (19.04%) but 37 adults (60.65%) and 17 children
hipocomplementemia, increased titers of Ac-an- (80.95%) had pituitary deficiency in varying de-
tiADNdc). Immunosuppression is postponed (pa- grees, most frequently monotropic deficiency. At
tients will), and despite the calcium blockers and diagnostic 5 adults (8.19%) and 7 children
antiplatelet therapy, acute ischemia of the second (33.33%) had central diabetes insipidus and im-
and third finger of the right hand occurs. paired visual acuity was found in 68.85% of adults
Results: Prompt immunosuppression with (42 cases) and 38.09% of children (8 cases). Post-
Cyclophosphamide i.v. is initiated and cortico- operative complications in adults were represent-
therapy increased, along with i.v. vasodilatators ed by: diabetes insipidus in 39 cases (63.93%) of
(PG1-alrostadil), and calcium blockers, antiagre- which 20 (51.28%) permanent and 19(48.71%)
gant and oral anticoagulant are continued, and transient diabetes insipidus and global pituitary
after 30 days of treatment, the accute ischemia insufficiency in 41 patients (67.21%). Postopera-
results into distal phalang necrosis of the second tive hormonal deficiency was worsened in 48 pa-
finger, and complete resolution of the ischemia in tients (78.68%), stationary in 11(18.03%) and im-
the third finger. proved in only 2 (3.27) cases. The postoperative
Conclusions: Patients with SLE have to be visual acuity was stable for 45.90 (28), worsened
closely monitored. To date, the exact etiology of for 31.14% (19) and improved for 22.95% (14)
SLE digital gangrene remains unclear and com- cases. Postoperative, in the under 18 years group,
plex with the presence of APS, overlap syndrome, 17 cases (80.95%) had diabetus insipidus, perma-
atherosclerosis, or vasculitis appearing as poten- nent in 13 (76.47%) with global pituitary insuffi-

ABSTRACTS
ciency in 16 cases (80%) and impaired vizual liorate urticaria with intermittently administration
acuicy was stable for 12(63.15%) and worsened of topical cutaneous corticosteroids.
for 6 (31.57%). Conclusion: Although PUPP is a benign dis-
Conclusions: Surgery is the treatment of ease, in some cases the differential diagnosis is
choice of craniopharyngiomas. However, in both difficult and requires good cooperation between
children and adults, the cure rate is suboptimal the obstetrician and allergologist.
and neurosurgical postoperative complications
are frequent, especially endocrine (pituitary fail- (250) Thyroid and metabolic
ure, central diabetes insipidus).
status in menopausal
(249) Pruritic urticarial women to whom surgery for
papules and plaques of primary
pregnancy vs fraxiparine hyperparathyroidism was
allergy performed
Adriana Mihaela Tudose1, Nicolae Viorel Adina Ghemigian1, Mara Carsote1,
Dumitrescu2, Dinu Albu1, Edu Antoine1 Andrei Goldstein1, Ana Valea1,
1
Nicoleta Dumitru1, Dana Terzea,
Davila, Bucharest, Romania Dumitru Ioachim2, Diana Paun1
2
Clinical Hospital N. Malaxa, Bucharest, 1
Romania Davila, Bucharest, Romania
2
Pruritic urticarial papules and plaques of preg- Bucharest, Romania
nancy (PUPP) is a benign skin condition that oc-
curs during pregnancy. Lesions usually occur in Objective: We analyze thyroid profile, car-
primigravidas at any time from the first trimester dio-metabolic components in subjects with iso-
through the postpartum period. lated PHPT.
Objective: Management of a woman case Methods: This is a non-selective case series
with hives. A 43 years woman with 16 weeks of analyses. Their latest evaluation was performed
pregnancy came to alergology for the suspicion of between July 2015 and March 2016.
allergy to fraxiparine. She was diagnosed with Results: 3 females were followed before and
thrombophilia and started the therapy with Fraxi- after parathyroid (PT) surgery: the age at disease
parine. After two weeks of therapy, she devel- confirmation was of 60 yrs (case 1), 63 yrs (case
oped abdominal hives, some with tendency to 2), 58 yrs (case 3). The peak total calcium levels at
forming plaques. Four years ago the patient re- onset were: 10.57 ng/mL, 10.5 ng/mL (normal
ceived treatment with interferon for chronic hep- <10.2 mg/dL), respective (rs.) 11.7 ng/mL; para-
atitis with VHC. thormone of 193 pg/ml, 104 pg/mL, rs. 284 pg/
Methods: After the first evaluation of the pa- mL (N <66 pg/mL); 25-hydroxyvitamin D of 9,
20, rs. 4 ng/mL. All patients had mild obesity, 2
tient, we stopped administration of Fraxiparine
females had high blood pressure, and first subject
and initiated the treatment with aspirin at 75 mg
associated hyperlipemia and uric diathesis. No
daily. Also, the patient was reevaluated in the in-
glucose metabolism anomaly was identified. Kid-
fectious diseases department that denied viral
ney stones were 100% presented while case 1
replication. and 3 had osteoporosis (L2 vertebral fracture, rs.
Results: In vivo tests are contraindicated in 5 fractures at upper and lower limb). PT-ectomy
pregnant women. Therefore we conducted initial was performed at 12, 14, rs. 13 months since di-
in vitro tests. Basophil degranulation test (BDT) agnosis (an inferior left adenoma was identified in
and lymphoblastic transformation test (LTT) for case 1 and 2 and left superior in case 3). Case 1
fraxiparine was negative. After these results, we had autoimmune hypothyroidism yet with a mac-
performed the administration of fraxiparine. It ronodular ultrasound pattern (as case 3); both
was well tolerated in terms of hypersensitivity re- case 2 and 3 had normal thyroid function. During
actions. Now, after we excluded an allergic reac- PT-ectomy, in case 1 and 3 the partial resection of
tion to fraxiparine, she is in the 27th week of thyroid associated L-thyroxine substitution further
pregnancy and takes this medication daily with- necessary. Case 2 had thyroid nodules of maxi-
out worsening the urticarial eruptions. Rarely, she mum 1 cm and during PT surgery the decision of
continues to describe some heaves and we ame- remove/biopsy was not done.

ABSTRACTS
Conclusion: In studied patients with PHPT, at (255) Adrenal tumors in

least one metabolic risk factor was positive; thy-
roid checks-up before and during PT surgery patients with kidney
made necessary a partial resection in some cases; removal surgery due to
hypovitaminosis D was confirmed in all cases.
unilateral renal cancer
(254) In vivo Adina Ghemigian, Mara Carsote,
micromorphological Anda Dumitrascu, Dana Terzea,
Nicoleta Dumitru, Ana Valea,
evaluation of cutaneous Dan Nicolae Paduraru, Sorin Paun,
neurovascular reactivity in Diana Loreta Paun
type 1 diabetes University of Medicine and Pharmacy Carol
Mihaela Adriana Ghita, Constantin Davila, Bucharest, Romania
Caruntu, Alexandra Batan, Daniela
Bucharest, Romania
Lixandru, Gabriela Cleo
Simionescu, Daniel Boda, Constantin Surgery for renal cancer (RC) do not necessar-
Ionescu-Targoviste ily involves adrenals remove so an endocrine tu-
mor at this level needs to be differentiated from
metastases.
Objective: To highlight the importance of en-
docrine panel in patients with a prior RC and ad-
Background: Peripheral neuropathy is a com-
renal tumor (AT)
mon complication in diabetes that plays an im-
Method: This is a case series report.
portant role in the development of foot ulcer-
Results: A 61-year female patient was admit-
ations and amputations. Altered cutaneous
microvascular response to various stimuli reflects ted for evaluation of a double incidentaloma: a
the dysfunction of small peripheral nerve fibers, thyroid nodule and a right AT. She had only one
considered to be initially damaged in diabetic kidney after surgery for a left RC, diagnosed 1
neuropathy. year ago. No chemotherapy was added but serial
Objectives: The aim of our preliminary study computed tomography scans were performed.
was to assess the reactivity of skin dermal micro- She associated type 2 diabetes mellitus, high
vascularization to topical capsaicin in type 1 dia- blood pressure under oral medication. Thyroid
betic patients through means of in vivo reflec- function was normal and fine needle aspiration
tance confocal microscopy. excluded showed well differentiated follicular
Method: The study was aproved and fullfills pattern. Adrenal profile showed chromogranin A
the requirements imposed by the local ethics co- of 84 ng/mL (Normal between 20 and 125 ng/
mittee. In vivo reflectance confocal microscopy mL), neuron specific enolase (NSE) of 5.25 ng/mL
using a wavelenghth of 785 nm was used to eval- (Normal between 0 and 12 ng/mL), normal
uate the papillary capillary vessels located at the 24-urinary metanephrines and normetanephrines
dermo-epidermal junction from the skin of 8 type and normal 1 mg dexametasone (DXM) overnight
1 diabetic subjects and 8 healthy volunteers, be- test. She also had hypovitaminosis D (25-hy-
fore and after 30 minutes of topical capsaicin droxyvitamin D of 24.9 ng/mL; Normal between
0.1%. 30 and 100 ng/mL), normal central Dual-Energy
Results: In vivo reflectance confocal micros- X-Ray Absorptiometry, and negative for metasta-
copy allowed the noninvasive morphological and ses whole body bone scintigram. Further imagery
dynamic evaluation of cutaneous microvascula- and endocrine follow-up was recommended.
ture and showed a significatly reduced vasodila- A 52-year female had the left kidney remove
tatory response of the papillary capillary vessels a decade ago for RC. 1 year after surgery a right
after 30 minutes of topical capsaicin in type 1 AT of 1.2 cm maximum diameter was discovered.
diabetic compared to healthy subjects. Yearly imagery scans (either computed tomogra-
Conclusions: In vivo reflectance confocal mi-
phy or ultrasound) were done without any chang-
croscopy is a reproducible tool for the nonivasive
es. She became hypertensive so an endocrine
assessment of the cutaneous neurovascular reac-
check up was recommended. Plasma cortisol af-
tivity that could be used for early detection of
ter low DXM dose was 0.88 g/dL with a NSE of
small peripheral nerves damage in type 1 diabe-
tes. 13 ng/mL (and normal chromogranin A of 72 ng/

ABSTRACTS
mL). Adrenal surgery was recommended because Results: In 2014, 94.78% of newborns were
of high NSE but the patient refused it. Neverthe- nationwide screened for PKU. We identified 21
less the CT scan 1 year later was status quo. positive patients. Further tests confirmed phenyl-
Conclusion: In the absence of surgery and as- ketonuria in 17 newborns.
sociated pathological report, close follow-up is Children with PKU disease were early treated
necessary regarding adrenal incidentalomas in and monitored by a multidisciplinary medical
patients with a prior surgery for renal cancer. The team. Furthermore, patients that were diagnosed
secretor profile excludes a secondary lesion but and correctly treated had a normal neurocogni-
adrenalectomy is required. tive development.
The PKU incidence in this study is 1/10 000
(256) Interdisciplinary infants.
Conclusion: National neonatal screening pro-
intervention to prevent gram for PKU provides social and economical
severe disability in children benefits for our community, due to the fact that
newborns can be diagnosed early on. Early diag-
Florentina Moldovanu1, Michaela nosis and treatment ensures a proper neurodevel-
Nanu1, Ioana-Roxana Muntianu2, opment of these patients and prevents morbidity.
Ioana Sonia Ardeleanu3
1
National Institute for Mother and Child Health (257) Acute adrenal
Alessandrescu-Rusescu, Bucharest, Romania insufficiency after insulin
2
Emergency Clinical Hospital Sf. Ioan, Bucharest,
Romania
tolerance test on a patient
3
University of Medicine and Pharmacy Carol with paraparesis and
Davila, Bucharest, Romania polydipsia
Phenylketonuria (PKU) is a rare inherited dis- Mara Carsote, Adina Ghemigian, Anda
order that increases the blood level of an essential Dumitrascu, Corina Chirita, Ana Valea,
aminoacid called phenylalanine. PKU is caused Corina Grigoriu, Simona Elena Albu,
by a defect in the gene that helps create the en-
zyme phenylalanine hydroxylase (PAH) needed
Cristina Vasiliu, Diana Loreta Paun
to convert phenylalanine into tyrosine. Conse- University of Medicine and Pharmacy Carol
quently, phenylalanine can reach harmful levels Davila, Bucharest, Romania
in the body, causing intellectual disability and National Institute of Endocrinology C.I.Parhon,
other serious health problems. Neonatal screen- Bucharest, Romania
ing for PKU in Romania is currently conducted
through the National Health Program. Insulin tolerance test (ITT) is a useful tool for
Objective: Early diagnosis and treatment of the confirmation of central adrenal insufficiency.
PKU in order to prevent neurological damage at The insulin dose is precisely calculated based on
children positive tested for this disorder. patient weight; yet sometimes severe reactions
Methods: We analyzed data from the 5 re- are registered in adults.
gional centers of PKU diagnosis (Bucharest, Cluj, Objective: We aim to describe an unusual se-
Iasi, Targu Mures and Timisoara). This data was vere reaction after ITT.
reported to the Implementation Unit of Health Methods: This is a case report. Endocrine
Programs since January to December 2014. Con- panel and medical history is exposed.
firmed cases were treated and monitored by a Results: A 33-year female patient was admit-
multidisciplinary medical team from these cen- ted for an endocrine assessment because of a few
ters. recent lipothymia episodes in association with an
All the newborns were tested using dry blood increased liquid intake up to 10 liters per day. She
spot (DBS) method. The test is usually done be- was known with paraparesis after a neurosurgical
fore a newborn leaves the hospital, in the first 48- procedure for lumbar disc herniation; hemor-
72 hours of life. rhagic gastritis; chronic hepatitis B, and untreated
Phenylalanine levels were assessed by immu- depression.
nofluorimetric method. The biochemistry parameters were within
Phenylalanine and tyrosine blood levels were normal limits, including ionogram. The systolic
measured to confirm the diagnosis of PKU at chil- blood pressure was between 90-100 mmHg
dren with positive screening tests. while she continued to have normal menses. The

ABSTRACTS
endocrine profile confirmed a normal thyroid junctivitis of the right eye and arthralgia. The
and gonad axes with normal increase of plasma patient also complains of progressive high water
cortisol after Synacthen stimulation test ruling out intake (15 liters per day), for the last year.
Addisons disease. A careful patient history showed the presence
A secondary adrenal insufficiency was sus- of recurrent hiposmia and epistaxis he patient be-
pected thus ITT was started with IV (intravenous) ing repeatedly evaluated in an Oto-Rhino-Larin-
0.1 U insulin/kg. Fasting plasma glucose of 77 mg/ gology Department for maxillary and ethmoidal-
dL decreased to 21 mg/dL within 19 minutes with sinusitis and multiple surgeries were performed.
a rapid correction after 2 vials of glucose 33% and The patient also associated migratory arthralgia,
continuous perfusion with glucose 5%. Less than erythema and edema of the right eye. Polydipsia
10 minutes after, the consciousness progressively was also present, approximately15 litters/ day.
deteriorated in association with low glycemia (be- The lab results showed inflammation, thrombocy-
tween 20 and 40 mg/dl) and rapid IV glucose did tosis. Immunology showed positive ds DNA anti-
not immediately correct it. For the next 10 hours bodies and c-ANCA antibodies. Other investiga-
7 vials of glucose 33%, 1500 ml of glucose 5%, tions revealed the presence of keratoconjunctivitis,
and 400 mg IV of hydrocortisone hemisuccinate with an intense positive Schirmer test. The tho-
were administrated to obtain a stable estate. The racic CT exposed the presence of pseudocavitary
levels of plasma cortisol at baseline were low (of nodular lesions in both lungs. The cerebral MRI
7.66 g/dl, normal between 7.36 and 22.6 g/dL) showed the presence of a nodular mass of the
and did not increase at hypoglycemia (a peak of pituitary gland.
6.4 g/dl) in association with a peak of growth Results: Taking into account the clinical, para-
hormone (GH) of 0.63 ng/mL (expected normal clinical and immunological findings the diagnosis
levels >10 ng//mL), confirming central adrenal was Granulomatosis with polyangitis with upper-
insufficiency and adult GH severe deficiency. and lower respiratory tract, musculoskeletal and
Magnetic resonance imagery did not point out ophtalmological involvement. At the onset there
was no renal involvement. The presence of the
any anomaly, polydipsia was diagnosed as psy-
polydipsia and the mass found in the MRI, arouse
chogenic and glucocorticoid substitution was rec-
the suspicion of a pituitary granuloma, a rare
ommended.
manifestation in this type of vasculitis.
Conclusion: Dramatic reaction at hypoglyce-
Immunosuppressive treatment was quickly
mia was correlated with hypopituitarism; the
initiated with corticosteroids and Cyclophospha-
cause is probably autoimmune despite the lack of
mide pulse- therapy, and then continued with
specific evidence.
oral cyclophosphamide. The evolution under
treatment was favorable with normalized lab re-
(259) Endocrine sults and abrupt decrease of the water intake (3li-
manifestation of ANCA- ters/day).
Conclusions: Sometimes the organ limited
associated vasculitis manifestations of a systemic disease can postpone
or reveal the correct diagnosis. In the presented
Sinziana Daia-Iliescu1, case the evolution was favorable under treat-
Casandra Buzatu1, Catalina Buta2, ment, with remission of polydipsia, but the diag-
Ruxandra Ionescu2 nosis and treatment have to be quick in order to
1 prevent irreversible changes like pituitary necro-
Department of Internal Medicine and
sis.
Rheumatology, Clinical Hospital Sf. Maria,
Bucharest, Romania
2
University of Medicine and Pharmacy Carol (260) The link between
Davila, Bucharest, Romania psychological disorders and
Objective: Cases of pituitary involvement in thyroid antibodies
granulomatosys with poliangiitis are rarely found
Alexandre Ionescu, Alexandra Cojocaru
in the medical literature. We report the case of a
patient with atypical debut presentation- polydip- University of Medicine and Pharmacy Carol
sia- of a rare sistemic disease-granulomatosis with Davila, Bucharest, Romania
poliangiitis.
Methods: We present the case of a 50-year- Objective: autoimmune thyroiditis, also
old female patient, admitted to one tertiary Rheu- known as Hasimotos thyroiditis (HT), is the most
matology Centre, for tiredness and fatigue, con- common autoimmune thyroid disease, with a

ABSTRACTS
higher prevalence in women. Also, it is the most which are rarely clinically significant at initial pre-
frequently cause of adult hypothyroidism in the sentation, and periodic follow-up is recommend-
world and is diagnosed with high titers of antithy- ed, according to current guidelines. We present a
roid peroxidase (ATPO) and antithyreoglobulin rare case of delayed onset of acromegaly in a pa-
(anti-Tg). Recent studies have shown a connec- tient with a pituitary incidentaloma, raising the
tion between HT and psychological disorders question of optimal follow-up schedules.
(obsessive-compulsive syndrome, anxiety, de- Methods: Clinical examination, biochemical
pression, etc.). Our review includes a number of and imaging studies.
studies, with the primary purpose being to find a Results: A 53 years old female presented with
link between high levels of ATPO and anti-Tg, a 11x5 mm pituitary mass discovered on a head
and psychological disorders. CT scan for headache. There were no clinical
Method: the study is a review of 3 different signs of pituitary hypersecretion and serum pro-
clinical studies on patients in which analyses are lactin and IGF-I levels were normal. On two year-
performed on thyroid function, while levels of ly follow-up visits CT scans showed non-progres-
Free Triiodothyronine, Free Thyroxine and Thy- sion of mass size and normal prolactin and IGF-I
roid-stimulating hormone indicate a normal func- levels. MRI follow-up scans after 10 and 13 years
tion of the thyroid. In the group study, ATPO lev- showed a stationary mass with cystic changes. Re-
els are elevated, indicating an euthyroid auto- cent onset of unexplained persistent hyperkale-
immune thyroiditis. In control groups, levels of mia prompted endocrine re-evaluation, 13 years
autoantibodies are below limits. Psychological after the initial diagnosis.
testing followed, through questionnaires that Clinical examination revealed mild skin hy-
evaluated the severity of different morbidities. perpigmentation and a small increase in shoe
Results: in each study, a strong correlation size. IGF-I levels were repeatedly abnormal (2.2-
can be noticed between elevated levels of ATPO 2.9 x ULN) and unsupressible growth hormone
and the onset of psychological symptoms, such as levels during OGTT, diagnostic for acromegaly.
depression, obsessive-compulsive disorder and
We discussed treatment options and the patient
anxiety. With serum levels of markers for thyroid
has been started on a trial of dopamine agonist,
function within normal limits, possible symptoms
with a view of pituitary surgery in case of lack of
created by a hypo- or hyperthyroidism are ex-
response.
cluded.
ACTH levels were high and increased progres-
Conclusions: there is a strong connection be-
sively while baseline serum cortisol levels were
tween the elevated levels of ATPO and the onset
normal, with subnormal response to synthetic
of psychological manifestations. Until now, no
ACTH, suggesting subclinical primary adrenocor-
correlation between these manifestations and
tical failure (Addisons disease). Adrenal CT imag-
high levels of Anti-Tg has been proven. Knowing
that an increasing number of auto-immune thy- ing excluded adrenal masses as a possible cause
roiditis cases with high Anti-Tg are being record- of Addisons and revealed an unexpected left ad-
ed, new grounds for research can be established. renal hyperplasia. 17 HO-progesterone levels
The etiology is not yet clear, but a number of hy- were elevated, suggesting concomitant congenital
potheses are proposed in order to truly under- adrenal hyperplasia, which would require genetic
stand the connection. testing of CYP21A mutations for confirmation.
The patient was commenced on glucocorticoid
and mineralocorticoid replacement.
(261) Delayed onset of Conclusions: Current guideline recommen-
acromegaly in a patient dations (Endocrine Society 2011) for pituitary in-
cidentaloma do not provide clear-cut follow-up
with an incidentally schedules; prolonged clinical and hormonal fol-
discovered pituitary mass, low-up may sometimes uncover delayed onset of
associated with primary endocrine disease. In our case, incidental hyper-
kalemia prompted endocrine re-evaluation re-
adrenocortical insufficiency vealing multiple endocrine abnormalities.
Diana Deciu
Bucharest, Romania
Objective: Pituitary incidentalomas are un-

suspected masses discovered on imaging studies,

ABSTRACTS
(270) Clinical features and 800 and 4000 mg with a mean dose of 1780 mg.
Remission under treatment was successful in 12
response to treatment in a cases. Adverse reactions were present in 5pa-
group of patients with tients (pulmonary infections)
Conclusions: Clinical manifestations of AN-
ANCA-associated vasculitis CA-associated vasculitis are polymorphic and
Casandra-Gabriela Buzatu1, they usually involve the upper and lower respira-
Sinziana Daia-Iliescu1, Ioana Saulescu2, tory tract. Renal involvement may appear later in
the disease evolution. Immunosuppression with
Andreea Borangiu1, Daniela Opris1, Cyclophosphamide is still the most used therapy
Ruxandra Ionescu2 for inducing disease remission.A prompt diagno-
1
Department of Internal Medicine and sis is necessary because the choices and duration
Rheumatology, Clinical Hospital Sf Maria, of treatment are dictated by the type of involve-
Bucharest, Romania ment, the severity of the disease and patients age.
2
Davila, Bucharest, Romania (272) Osteoporotic
Objective: The aim of the study is to raise fractures: the risk of falling
awareness in a rare group of diseases, ANCA-as- represents an unexpected
sociated vasculitis, in which there still isnt a gold
standard of care. In the early phases of the dis-
package beyond Trabecular
ease, the symptoms are non-specific, the diagno- Bone Score and Bone
sis is delayed and the mortality is high. Mineral Density
Methods: We performed a study on a cohort
of patients diagnosed with ANCA-associated vas- Nicoleta Dumitru, Mara Carsote,
culitis followed in one tertiary Rheumatology Simona Elena Albu, Ana Valea, Corina
Centre. We evaluated the clinical and immuno- Grigoriu, Cristina Vasiliu, Diana Loreta
logical features, choices of treatment and re-
sponse to therapy. We used Windows Excel/ Paun, Adina Ghemigian
SPSS20.0 University of Medicine and Pharmacy Carol
Results: The study group included a total of Davila, Bucharest, Romania
18 patients (13 patients diagnosed with granulo-
matosis with polyangiitis, 3 patients with eosino- Objective:The fragility (osteoporotic) frac-
philic granulomatosis with polyangiitis and 2 pa- tures are caused by three distinctive parameters:
tients with microscopic polyangiitis), 10female quantitative skeletal features as pointed by Bone
and 8male patients with a mean age of 49,8at the Mineral Density (BMD) at Dual-Energy X-Ray Ab-
time of the diagnosis. The female patients were sorptiometry (DXA) scans; micro-architecture -re-
between 37 and 75 years of age with a mean age lated qualitative points as expressed by Trabecu-
of 54.7 years. The male patients were between lar Bone Score (TBS) and the risk of falling related
21and 61years of age, with a mean age of 42.75. to hypotension, hypoglycemia, muscle force as
The first organ involvement present at the on- reflected by vitamin D (VD) status, etc. We aim to
set of the disease was as it follows: upper respira- analyze a female case who had a fragility fracture
tory tract in 11 patients (sinusitis, otitis, dyspho- registered despite good results of TBS and BMD
nia), lower respiratory tract in 7patients (unilateral dynamics based on anti-osteoporotic therapy but
nodular lesions, cavernous nodular lesions in un-controlled risk of falling on a VD independent
both lungs) and musculoskeletal involvement in 6 way.
patients. There were also 3 cases of Ophthalmo- Method: The data of bone metabolism are
logical, cutaneous and renal involvement. Renal provided: BMD (GE Lunar Prodigy machine), TBS
involvement (hematuria, proteinuria) developed (iNsight software); VD is assessed by 25-hy-
in 11patients. droxyvitamin D (25-OHD; ELISA kit; normal lev-
As for the treatment, the induction of remis- els >30 ng/mL). Informed consent of the patient
sion was initiated with high doses of cortisone in was signed in April 2016.
4 patients, Azathioprine and corticosteroids in 1 Results: A 61-year old non-smoker female
case and combined pulse therapy with Cyclo- with irrelevant personal and family history had
phosphamide and cortisone in 13 cases (for renal menopause at age of 48 years (without replace-
and lower respiratory tract involvement). Cyclo- ment therapy). 2 years later she suffered a fragility
phosphamide induction dosage was between fracture at right external malleolus, and central

ABSTRACTS
DXA confirmed menopausal osteoporosis. She a protrusional lesion negative for neoplasia. Sub-
was offered strontium ranelate for 2 years when sequently, the patient developed pain and func-
she suffered a second fracture at left external mal- tional impotence on the upper and then in the
leolus and treatment was switched to risendro- lower limbs. Clinical examination revealed
nate weekly for 4 years and another year of intra- marked functional impairment of the limbs and
venous Ibandronate every 3 months. At this point the lab results showed high inflammation
DXA showed L1-4 lumbar BMD of 0.841g/sqcm, (ESR=120 mm/h, CRP=118.86 mg/l,), chronic
T-score of -2.8SD, Z-score of -1.9SD; L1-4 TBS normochromic normocytic anemia (Hb=10.1 g/
was of 1.093, and 25OHD was 40 ng/mL. Thera- dl), and normal muscle enzymes, rheumatic fac-
py was continued the same but 6 months later tor negative, ACPA negative. An imagistic and
she suffered a new fracture at right arm after fall- blood marker screening for cancer was performed
ing on ice (surgery was necessary) despite BMD and resulted negative. Musculoskeletal ultra-
and TBS improved: L1-4 BMD of 0.904 g/sqcm, sound of the shoulder show left bicipital tenosy-
T-score of -2.3SD, Z-score of -1.5SD, and TBS of novitis, bursitis and long head biceps tenosynovi-
1.172. Further bone forming teriparatide therapy tis. Thus, the diagnosis of Polymyalgia rheumatica
was introduced. (PMR) was made and low-dose corticosteroids
Conclusion: This case highlights a few aspects were initiated.
on skeletal field: regardless the anti-osteoporotic Results: The response to low-dose corticoste-
drugs the risk of fracture is reduced, not canceled; roids was favorable, with rapid clinical and bio-
an osteoporotic fracture registered early after logical improvement, with a CRP value, lowering
menopause indicates a fast bone looser pheno- to half in 48 hours, which is one strong argument
type with augmented risk for cascade fractures; in favor of a rheumatic disease per se. In spite of
risk of falling is not corrected despite therapy and the good evolution the neoplastic screening was
improvement of BMD, and adequate 25OHD; continued and a second UGI endoscopy was per-
TBS assays are among the first tested in Romania formed showing at this time a lesion positive for
because of novelty method.
squamous cell carcinoma of the middle part of
the esophagus and the patient was referred to a
(275) Active cancer gastroenterology clinic for further investigations.
surveilance in polymialgia Conclusions: Although the cancer incidence
among PMR patients is not very high, clinicians
rheumatica should always closely and prompt screen for an
accompanying cancer during the first months af-
Sinziana Daia-Iliescu1, Catalina Buta2,
ter a PMR diagnosis is made.
Ioana Saulescu3, Ruxandra Ionescu1
1
Department of Internal Medicine and (278) Complications of
Rheumatology, Clinical Hospital Sf. Maria,
Bucharest, Romania glucocorticoid treatment of
2
University of Medicine and Pharmacy Carol a non-compliant patient
with systemic lupus
Objective: To raise awareness of the impor- erythematosus case report
tance of active cancer screening in patients with a
rheumatic disease as sometimes the rheumatic Marina Alina Bara, Razvan Fodoroiu,
features may reveal or postpone the diagnosis of Teodoru Saman Stefan
a neoplastic disease. University of Medicine and Pharmacy Carol
Methods: We present the case of a 74-year- Davila, Bucharest, Romania
old patient who presented in a tertiary Rheuma-
tology Centre complaining of intense muscle pain OBJECTIVES: Systemic lupus erythematosus
and stiffness in the upper and lower limbs, with (SLE) is a chronic inflammatory disease that can
the impossibility to rise or climb the stairs, in the have multiple systemic effects in the human body.
last month. He associated mild dysphagia and
More than 90% of cases of SLE occur in women,
weight loss (5hg/ 1year) but the upper gastrointes-
frequently starting at childbearing age and follows
tinal (UGI) endoscopy and biopsy were negative
a relapsing and remitting course. The purpose of
for neoplasia and evolution was stable under
our case report is to present the evolution and
treatment.
complications that occur when a patient with SLE
Following the last three months, the patient
is non-compliant.
had easy dysphagia for solids and UGIE detected

ABSTRACTS
Methods: We report the case of a 58-year-old (281) High-risk HPV genital

woman presenting middle back pain who recent-
ly developed thoracic kyphosis.The pacient was infection in women and
diagnosed with SLE at the age 56 when she satis- anal dysplasia
fied the requirements of Systemic Lupus Interna-
tional Collaborating Clinics (SLICC) with 4 criteria Corina Grigoriu1, Mihai Grigoriu2,
including acute cutaneous lupus, arthritis, posi- Irina Horhoianu2, Lucica Elena Visan1,
tive antinuclear antibodies (ANA) and positive Violeta Simona Coravu3
anti-dsDNA antibodies. Medications used to treat 1
SLE manifestations of the pacient included Meth- University of Medicine and Pharmacy Carol
ylprednisolone (MPD), Hydroxychloroquine and Davila, Bucharest, Romania
2
Aceclofenac. Despite the doctors instructions to Departament of Obstetrics/Gynecology,
take 4 mg /day MPD for 3 months and then come Emergency University Hospital, Bucharest,
for a reevaluation, the patient took 16 mg/day Romania
3
MPD for 2 years. Clinical examination revealed Departament of Surgery, Emergency University
Cushingoid facies, malar rash, macular rash in the Hospital, Bucharest, Romania
anterior cervical and thoracic region, truncal obe-
sity and thoracic kyphosis. Osteodensitometry Objectives: The majority of sexually active
revealed severe osteoporosis and the chest radi- women will acquire anogenital HPV at some
ography showed T11-T12 vertebral compression point in their lives. The presence of cervical HPV
fractures. is a major risk factor for anal HPV. The aim of our
Results: The final diagnosis was Iatrogenic study is to verify the coexistence of anal warts or
Cushing Syndrome due to an administration of anal dysplasia in HR HPV patients.
excessive amounts of glucocorticoid. The main Method: We examined 20 women with visi-
characteristic of our case report consists in the pable perianal warts and 30 women known with
tients lack of treatment adherence which led to cervical intraepithelial disease, all of them with
an unfavorable evolution from a barely symptho- positive cervical HR HPV (16, 18, 31). We per-
matic SLE, diagnosed at an uncommon age, into formed visual inspection, anal cytological smears
an Iatrogenic Cushing Syndrome with severe and anuscopy.
complications. Results: Clinically, HPV infection of the anal
Conclusion: Among the multiple SLE compli- area can present as benign warts (condyloma
cations, there are also glucocorticoid treatment acuminata), dysplastic lesions (anal intraepithelial
related complications which rely on the patients neoplasia), or a combination of both.
adherence to the treatment. Without cardiac, re- We observed pedunculated warts (14 cases)
nal or neurologic complications and with a prop- and warts which grow in radial rows around the
er treatment, SLE has a good prognosis showing anus (6 cases). Some of them extended into the
increased bone density and a decrease in possible anal canal as far as 2 cm above the dentate line
bone fractures. Instructing the patients with SLE (seen during anuscopy). Symptoms associated
to adhere to treatment, seek medical care for with anal warts included the presence of a raised
evaluation of new symptoms (including fever) lesion, pruritus, bleeding, discharge and pain.
and advising them regarding their hightened risks Anal intraepithelial neoplasia (AIN) was diag-
for infection and cardiovascular disease is very nosed after acetic acid 5% application to the peri-
important for managing the disease. anal area. The most frequent appearance was as
flat, dysplastic (16 cases) and neoplastic lesions (5
cases). We performed high resolution anuscopy
to explore intra-anal disease, which was con-
firmed in two patients. The therapeutical ap-
proach was application of topical agents (podo-
phyllotoxin, imiquimod, and trichloroacetic acid).
Timely diagnosis and treatment of AIN is impor-
tant to prevent progression into invasive anal
SCC. Topical imiquimod 5 percent is an effective
treatment of AIN.Surgical therapy included wide
local excision and targeted destruction.
Conclusion: The coexistence of HR HPV in
cervical and anal dysplasia is of real concern for
both women and practitioner. Following treat-

ABSTRACTS
ment, long-term surveillance is essential to treat (284) Single centre

recurrence and prevent progression for both cer-
vical and anal cancer in HR HPV women. Al- experience with collagen
though routine screening remains controversial, IV-related nephropathies
screening with anal cytology is suggested.
Diana-Silvia Zilisteanu1, Elena-Emanuela
(282) Thrombophilia Rusu2, Teodora Atasie1, Adriana Neatu1,
Mihai Voiculescu2
screening and hormonal 1
contraception Davila, Bucharest, Romania
2
Corina Grigoriu1, Irina Horhoianu2, Department of Nephrology, Fundeni Clinical
Institute, Romania
Mirela Nicolae1, Andreea Mihart2
1
University of Medicine and Pharmacy Carol Collagen IV-related nephropathies family
Davila, Bucharest, Romania comprises a spectrum of phenotypes from Alport
2
Department of Obstetrics-Gynecology, syndrome (AS) to thin basement membrane ne-
University Emergency Hospital, Bucharest, phropathy (TBMN).
Romania We present the evolution of 6 patients (pts)
with AS and 8 cases with TBMN diagnosed in our
Objectives: Epidemiologic studies suggest centre by renal biopsy.
that oral estroprogestatives increase the risk of The 6 cases with AS were males, and average
thrombosis, due to estrogens and their dosage. age at onset was 28.2 +/- 16.7 years (yrs). All AS
The effect is related to the increased synthesis of pts presented with microscopic hematuria and
pro-coagulant factors. The effect on anticoagu- proteinuria (mean value 5.2 +/- 4 g/day). Renal
lant parameters (protein S, C and antithrombin function was affected at onset in 4/6 pts, with
III) is less known. mean serum creatinine 1.47 +/- 1.14 mg/dl; two
Method: Due to possible serious complica- pts developed progressive renal failure and
tions during pregnancy, we observe that a lot of reached ESRD at 22 yrs, and 25 yrs respectively.
our patients perform screening tests for thrombo- Hypertension was diagnosed in 3/6 AS pts. 4/6 of
philia. Associated with familial or personal history, AS patients were diagnosed with bilateral sensori-
we manage to diagnose far more patients with neural hearing abnormalities. Every AS pt re-
several mutations with thrombotic risk (mutations ceived antiproteinuric treatment, either was hy-
of MTHFR and PAI genes, mutations of factor pertensive or not: with ACEI in 4 pts, sartans in 1
XIII). This patients will need also further contra- pt, and both in 1 pt.
ception. Actual recommendations are a nonestro- In 8 pts with TBMN, males/females = 1, aver-
genic pills. We studied 65 women, which due to age age at onset was 24.1 +/- 13 yrs. Most com-
family or personal history are considered with mon findings were hematuria in 7/8 cases (mac-
high risk for thrombotic events. roscopic in 3/8 pts) and proteinuria in 4/8 cases
Results: For patients who desire oral hormon- (mean value 1.3 +/- 3.1 g/day), with only 1 pt
al contraception, with personal risk factors (obe- with NS. 4/8 cases developed renal failure from
sity, smoking etc) a thorough familial thrombotic the beginning, mean serum creatinine 1.56 +/-
history should be taken. The history investigates 1,37 mg/dl. One pt had mild elevation of blood
acute thrombotic events and possibly thrombosis- pressure; 2 pts received ACEI treatment. None of
related events in young relatives (under 50 years) TBMN pt had hearing problems during follow up.
or pregnant relatives. If this history is positive, Two TBMN patients presented associated lesions
screening tests for thrombophilia are mandatory. at renal biopsy: IgA nephropathy in a 48 years
From our 65 patients series, 49 tested positive for age male patient with HBV infection, and FSGS in
the abovementioned mutations. After counseling, a 21 years age female patient; both of them de-
41 choose a nonhormonal birth control method, veloped renal failure and were treated by immu-
for the eight left, low-dose estrogen containing nosuppressive therapy with a favourable evolu-
pills or progestative-only pills were recommend- tion.
ed. In conclusion, renal involvement is significant
Conclusions: Positive familial history for not only in AS, but also in TBMN. In AS, patients
thrombophilia should be a strong motivation for can reach ESRD in early adulthood; also in TBMN
screening patients who desire oral contraception. some cases develop renal failure from the begin-
ning, which worsen the middle and long-term

ABSTRACTS
prognosis.Considering there are genetic disor- tors and developed osteonecrosis. While for the
ders, testing of relatives at risk by urinalysis is ad- RA patients, the corticosteroid therapy can be a
visable, in order to detect and diagnose the as- cause of osteonecrosis, for the AS patients the
ymptomatic affected individuals. main factor seems to be the use of TNF- inhibi-
tors. The development of osteonecrosis during
(285) Aseptic osteonecrosis- the biological treatment and the later occurrence
in the patients with higher risk factors sustain the
adverse effect of TNF- pathogenic role of TNF- inhibitors in osteone-
inhibitors? crosis.
Conclusions: Although more demonstrations
Georgiana Druncea, Ioan-Andrei are needed, our case series could represent a be-
Cristache, Doina Ramba, Simona ginning for further clinical studies. Avascular os-
Caraiola teonecrosis is a severe and debilitating condition
which should be investigated as possible adverse
University of Medicine and Pharmacy Carol reaction of TNF- inhibitors, considering the
Davila, Bucharest, Romania widespread use of this therapy.
Objective: Tumor necrosis factor-alpha

(TNF-) is a key regulator in inflammation. New (287) Secondary
studies proved the pathogenic role of TNF- in hypertension due to
aseptic osteonecrosis by promoting osteoclasto-
genesis and endothelial dysfunctions. Anti-TNF-
primary aldosteronism an
therapy seems promising in osteonecrosis, but audit of diagnosis,
there is still little evidence. Recently, osteonecro- treatment and follow-up in
sis has been noted as possible adverse effect of
anti-TNF- therapy. The aim of our presentation a tertiary endocrine center
is to describe and analyze four cases of patients Alexandra Smarandoiu1, Raluca
with rheumatic diseases, treated with TNF- in-
hibitors, that developed aseptic osteonecrosis
Trifanescu2, Andra Caragheorgheopol1,
during the treatment. Anda Dumitrascu1, Catalina Poiana1
Method: We observed two patients with 1
National Institute of Endocrinology C.I. Parhon,
rheumatoid arthritis (RA) and two with ankylosing Bucharest, Romania
spondylitis (AS). The patients having RA were a 2
30-year-old woman and a 47-year-old man. After Davila, Bucharest, Romania
an unsuccessful combination of disease-modify-
ing antirheumatic drugs (DMARDs) (methotrex- Objectives: To analyze clinical and biochemi-
ate, leflunomide, sulfasalazine) and small doses of cal characteristics in a group of patients with pri-
corticosteroids, both subjects received an associa- mary aldosteronism (PA) as compared with pa-
tion of DMARDs and TNF- inhibitors (etaner- tients with essential hypertension.
cept, adalimumab, respectively). After four years Methods: Medical records of 30 patients with
of biological treatment and three and a half years, primary aldosteronism (19F/11M, aged 35.5
respectively, the patients developed aseptic os- 10.9 years at hypertension onset) and 41 control
teonecrosis. hypertensive patients matched for age and body
The patients having stage 3 AS: a 40-year-old mass index (16M/25F, aged 35.6 14.7 years)
woman and a 40-year-old man, received similar without mineralocorticoid excess, were retro-
therapies: NSAIDs and etanercept (the man respectively reviewed. Plasma aldosterone and
ceived extra sulfasalazine therapy for non-axial plasma direct renin were measured by chemilu-
involvement). Both developed osteonecrosis after miniscence (CLIA - methods sensitivity 2.2 ng/dl
six months of biological therapy and after 1 year for aldosterone and, respectively, 0.27 ng/dl for
and a half, respectively. renin). Blood collection and diagnosis of PA were
The diagnosis of osteonecrosis was based on performed according to guidelines, using screen-
symptoms, aspect on magnetic resonance imaging and confirmatory tests (Captopril challenge or
ing and/or plain radiology (affected bones: talus, saline infusion tests). Whenever possible, drugs
navicular bone and femoral head). interfering with renin-aldosterone axis were with-
Other causes of osteonecrosis were excluded. drawn.
Results: All the patients have rheumatic dis- Results: Maximum systolic blood pressure in
eases, were treated with different TNF- inhibi- patients with PA (214 28 mmHg) was signifi-

ABSTRACTS
cantly higher than in control patients (195 25 Methods: The research was conducted be-
mm Hg, p=0.009). Median time from hyperten- tween 2010-2014 as a retrospective, descriptive
sion onset to diagnosis of PA was 5 years, ranging and observational study conducted on a sample
between of 102 female patients diagnosed with breast can-
0.5-25 years. Median number of antihyper- cer and registered in the Dpartment of Oncology
tensive drugs used for blood pressure control in of Hospital Dr. Constantin Gorgos in Bucharest.
PA patients was 3. Serum kalemia in patients with Data were analyzed using IBM SPSS Ver. 22 soft-
PA was significantly lower (3.06 0.9 mmol/l) ware.
than in control patients (4.3 0.3mmol/l, Results: The mean age of the patients was 58
p<0.0001). years (95% CI 55.35 to 60.67). 43% of patients
20 out of 30 patients diagnosed with PA had stage II cancer and 39% expressed inflamma-
(66.67%) presented hypokalemia at diagnosis. tory syndrome. Associated comorbidities were
Maximum diastolic blood pressure, fasting gly- identified in 75% of patients. Among cardiovas-
caemia, total cholesterol were similar between cular pathology, we identified primary hyperten-
the two groups. Computed tomography imaging sion in 36 patients (35.29%), ischemic heart dis-
revealed unilateral adrenal tumor in 15 cases, ease in 20 patients (19.6%), heart failure in 12
while adrenal hyperplasia and/or bilateral adrenal patients (11.76%) and cardiac arrhythmias in 6
tumors in 15 cases. Adrenal vein sampling was patients (5.88%) Other comorbidities were: dys-
not available, so surgery was performed in only lipidemia (16 patients, 15.68%), pneumopathy
10 patients, with normalization of kalemia and (15 patients, 14.70%), diabetes (22 patients,
control of hypertension in 8 patients (80%). Min- 21.56%) and chronic viral hepatitis (4 cases,
eralocorticoid antagonists were used in the other 3.92%). For 47% of patients comorbidities were
22 patients. discovered at the time the diagnosis of breast
Conclusion: primary aldosteronism was diag- cancer was made. Of these, 39% (n = 19) were
nosed after long term evolution of hypertension, non-adherent to the associated treatment and
even in young patients; precocious referral for had a worse prognosis compared to patients who
endocrine work-up and adrenal vein sampling accepted therapy of comorbidities.
were expected to improve outcome of surgical Conclusions: Breast cancer associated co-
treatment. morbidities should be identified as early as possi-
ble. A different management strategy of these
(288) The incidence and patients should be adopted (specific treatment
and follow up) in order to reduce mortality.
importance of comorbidities
in female patients (290) Patterns of
diagnosed with breast nephrology referral and
cancer dialysis initiation in chronic
Mircea Lupusoru1, Mariana Besoiu1, kidney disease patients
Gabriela Lupusoru1, Dumitru Ferechide2,
Diana-Silvia Zilisteanu1, Elena-Emanuela
Ionel Alexandru Checherita1, Elena
Rusu2, Teodora Atasie1, Adriana Neatu2,
Bordea1, Angelo Pelegrini1, Mihaela
Mihai Voiculescu
Banu1, Ruxandra Sfeatcu1, Antoaneta
1
Punga1, Diana Bunescu1, Anca Ioana University of Medicine and Pharmacy Carol
Badarau1 2
Department of Nephrolog, Fundeni Clinical
1
University of Medicine and Pharmacy Carol Institute, Bucharest, Romania
2
Titan Psychiatric Hospital Constantin Gorgos, Late referral to nephrologist (less than six
Bucharest, Romania months before dialysis initiation) of chronic renal
failure patients (pts) can lead to urgent unpre-
Background: Identifying comorbidities in pa- pared dialysis start, with increased morbidity and
tients with breast cancer is very important. Co- mortality.
morbidities affect both the total mortality rate and We retrospectively assessed 340 pts (males =
breast cancer specific mortality, thus the manage- 178, mean age = 54.56 +/- 15.57 years admit-
ment of these patients is different, with a greater ted for dialysis initiation. 177 (52.1%) pts were
focus on treatment. late referred (LR), while in 163 cases (47.9%)

ABSTRACTS
were early referred (ER). Hemodialysis was the (293) Serum

preferred method either in the LR group (74%),
or in the ER group (52.8%). Central venous cath- osteoprotegerin is
eter (CVC) was used in 121 pts (68.4%) from LR associated with
group, and in 71 pts (43.6%) from ER group; arte-
riovenous fistula (AVF) was used in in 18 pts
symptomatic heart failure
(10.2%) from LR group, and in 25 pts (15.3%) with normal left ventricular
from ER group; peritoneal dialysis (PD) was used ejection fraction in CKD
in in 38 pts (21.5%) from LR group, and in 67 pts
(41.1%) from ER group. patients
Three months survival after dialysis initiation Diana-Silvia Zilisteanu1, Elena-Emanuela
was lower in LR group (84.6%) compared to ER
group (89.4%), but without statistical significance
Rusu1, Monica Rosca1, Cristiana Tanase1,
(p=0.18); the difference was significant when Teodora Atasie2, Adriana Neatu1, Mihai
analysed 12 months survival: 77.6% in ER group Voiculescu1
versus 69.9% in LR group (p=0.02). We found 1
highest mortality in pts emergently included in Davila, Bucharest, Romania
hemodialysis via CVC (37.7%) when compared to 2
Department of Nephrology, Fundeni Clinical
pts initiated using AVF (12.1%) or with pts includ- Institute, Bucharest, Romania
ed in PD (13.6%).
Complications were significantly more fre- Objectives: Heart failure (HF) is common and
quent in pts dialysed using CVC compared to pts appears early in the evolution of chronic kidney
dialysed by AVF or PD: fluid overload in 36% vs disease (CKD). The aim of our study is to identify
13% pts (p<0.0001), pericarditis in 27% vs 14% markers associated with symptomatic HF in CKD
pts (p=0.008), cardiac failure in 54% vs 28% pts patients with normal left ventricular ejection frac-
(p = 0.0001), arrhythmia in 33% vs 15% pts tion.
(p<0.0001), pleural effusion in 35% vs 13% pts Methods: We prospectively enrolled 90 CKD
(p<0.0001), neurological disorders in 3% vs 8% patients (pts) in pre-dialysis. Heart functional sta-
pts (p<0.0001), hemorrhagic syndrome in 26% tus was defined according to the NYHA classifica-
vs 7% pts (p<0.0001). tion. Were evaluated echocardiographic param-
Clinical outcome and survival is better in CKD eters of cardiac structure and function. xMAP
patients early referred to nephrologist. In clinical technology was used to evaluate inflammatory
practice, dialysis is often delayed, and is initiated and mineral metabolism markers: FGF-23, osteo-
using CVC, even in timely referred patients. This pontin, osteoprotegerin, osteocalcin, iPTH, IL-6,
delay can abolish the potential benefits of timely TNFalpha. All patients underwent 24 hour ambu-
referral. latory blood pressure monitoring and peripheral
pulse wave analysis.
Results: We enrolled 90 CKD patients (10 pa-
tients CKD stage 2, 58 patients CKD stage 3, 22
patients CKD stage 4), men = 64, age=64.8
11.4 years (yrs). All study patients had EF 50%.
22 patients were in NYHA class 1, 49 patients
were in NYHA 2 and 19 patients were in NYHA
class 3. Pts with symptomatic HF (NYHA class
2) were older (68 10 yrs vs 5611 yrs,
p<0.05), had lower eGFR (37.212.9 vs 5523
ml/min/1.73 m2, p<0.05), higher LAVI (42.5
17.5 m;/m2, p<0.05), higher LVMI (120.729.9
vs 105.520.6 g/m2, p<0.05), lower E/A
(0.840.25 vs 1.040.37, p<0.05) and higher
E/E` (12.63.5 vs 9.82.8, p<0.05). Also, we
found significantly higher levels of IL-6 and OPG
in NYHA 2-3 patients (p<0.05). In univariate
analysis, symptomatic HF was correlated with
LAVI (p=0.02), LVMI (p=0.043), E/A (p=0.024),
E/E` (p=0.001), IL-6 (p=0.015), fibrinogen

ABSTRACTS
(p=0.041), eGFR (p<0.0001), uric acid Higher fetuin-A level was significantly associ-
(p=0.003), OPG (p=0.003), OPN (p=0.02) and ated with increased eGFR (p=0.006) and hemo-
average systolic blood pressure (p=0.009). No globin (p=0.029), and negatively associated with
correlations with pulse wave velocity parameters LAVI (p=0.025), ASr (p=0.029), LVMI (p=0.014),
were identified. Binary logistic regression analysis IMT (p=0.01), arterial pressure (p=0.046).
identified eGFR (p=0.029), OPG (p=0.003) and A stepwise multiple regression analisys re-
E/E` (p=0.035), as markers of symptomatic HF. vealed that left atrial contractile function param-
Conclusions: In our study, 65.6% patients eter (ASr) was independentely correlated with fe-
with normal LV ejection fraction had symptomat- tuin-A level (= -0.381, p=0.018) and age
ic HF, evaluated as NYHA 2. Symptomatic heart (=0.559, p=0.001). Also, on stepwise multiple
failure was associated with more advanced CKD. regression, only ASr was independenly associated
Our results suggest that OPG is a marker of symp- with the presence of cardiac failure symptoms.
tomatic HF in CKD. LAVI and was significanly increased in patients
Acknowledgement: This work was partially with heart failuresymptoms.
supported by a grant of the Romanian National Our study shows that fetuin-A correlated with
Authority for Scientific Research, CNDI- UEFISC- LA function and LAVI. LA contractile dysfunction
DI, project number PN-II-PT-PCCA-2011-3.2-079. was the main factor associated with the presence
of symptoms, suggesting that it could better re-
flect cardiac involvement with clinical conse-
(296) Serum Fetuin-A with quences in CKD patients.
left atrial size and function Acknowledgement: This work was partially
supported by a grant of the Romanian National
in patients with chronic Authority for Scientific Research, CNDI UEFISC-
kidney disease DI, project number PN-II-PT-PCCA-2011-3.2-
0794.
Elena Rusu1, Monica Rosca2,
Andreea Calin3, Simona Mihai3,
(298) Data regarding
Cristiana Tanase3, Teodora Atasie3,
Adriana Neatu4, Diana Zilisteanu4 epidemiology and clinical
1
aspects of hydatidosis in
Institute, Bucharest, Romania children
2
Gabriela Loredana Popa1, Corina
3
Emergency Institute for Cardiovascular Diseases Constantin1, Bogdan Mastalier1, Cosmin
Prof. Dr. CC. Iliescu, Bucharest, Romania Alexandru Popa2, Patricia Mihailescu1,
4
National Institute for Research and Iulia Tanase1 Marius Petrutescu3, Mircea
Development in Pathology and Biomedical Ioan Popa2, Carmen-Michaela Cretu1
Sciences Victor Babes, Bucharest, Romania
1
The aim of this study was to evaluate associa- Davila, Bucharest, Romania
2
tions between serum fetuin-A and echocardio- Colentina Clinical Hospital (CDPC), Bucharest,
grafic parameters of left atrial (LA) volume and Romania
3
function in patients with chronic kidney disease FP7 Project HERACLES Grant 602051/2013
(CKD).
We enrolled 95 CKD patients (65.111.2 Objective: Hydatid disease (Cystic echino-
years, 67 men) in pre-dialysis (10 patients with coccosis, CE) still represents an important public
CKD stage 2, 62 patients stage 3, 23 patients health issue. Socio-economic risk and cultural
stage 4). Fetuin-A was measured using xMAP factors, uncontrolled slaughter of livestock, and
technology. Echocardiographic evaluation includ- unsanitary living conditions are some of the main
ed: indexed left atrial volume (LAVI), left ventric- factors for human CE. Our objective was to ana-
ular mass index (LVMI), LV dyastolic and sistolic lyze and describe the data related to epidemiol-
function, and two-dimensional speckle-tracking ogy and clinical aspects of CE in children.
echocardiography. We obtain LA reservoir, con- Methods: Out of more than 2,500 patients
duit and contractile (atrial function strain rate registered in our database (2000-2015) with CE,
ASr) functions. We evaluated intima-media thick- we selected for this study 186 children. We did a
ness (IMT) by ultrasonographic study of the retrospective study, analyzing diagnostic and the-
common carotid arteries. rapeutical aspects.

ABSTRACTS
Results: Most of the children came from rural and 70.7% presented insulin resistance. The pres-
areas. 87 cases had a primary localization and in ence of CKD was significantly associated with in-
99 cases relapses were identified. Regarding the sulin resistance and hypertension (p<0.05). A
first organ infected, the lungs were the case for stepwise multiple regression analysis showed that
34.4% of our patients, followed by the liver age (p=0.002), arterial hypertension (p=0.01)
(31.18%), lungs and liver (19.9%), and other lo- and serum trombocytes (p=0.04) positively asso-
calization (14.52%). The hydatic cyst was unique ciated with eGFR (p<0.0001). Hepatic steatosis
in 41.9% of our cases. More cysts were diagnosed grade positively correlated with eGFR and inflam-
in the other patients. Most of the detected cysts mation on liver biopsy. We didnt find correlation
had a scale between 3 and 6 cm. Two suggestive between liver fibrosis and eGFR.
cases will be presented. Our results indicate a significant association
Conclusions: Hydatidosis represents a public between insulin resistance, arterial hypertension
health problem in Romania, affecting children and CKD in patients with NAFLD. This study
and adults. It could be related with invalidating show that is important to evaluate the risk factors
evolution, tendency to relapses and a quite im- for CKD in NAFLD patients, in order to treat them
portant mortality rate. Hydatidosis treatment is and to prevent CKD developing in NAFLD pa-
individualized, medical, surgical and mixed, de- tients. Specialists and practicing clinicians should
pending on each case. The diagnosis is based on be aware of the association between NAFLD and
imaging, serological and clinical data. CKD, especially because of the high and growing
prevalence of CKD and NAFLD.
The study was partially supported by grant
(299) Chronic kidney PN-II-ID -PCE-2011-3-0917, no. 297/2011 of the
disease is significantly Romanian Ministry of Education represented by
UEFISCDI.
associated with insulin
resistance and hypertension (303) Radiological
in patients with interstitial syndrome and
nonalcoholic fatty liver mediastinal adenopathy at
disease a patient under treatment
Elena Rus1, Raluca Pais2, with Interferon y for
Diana Zilisteanu2, Vlad Ratziu3 Hepatitis C
1
Andreea Cristina Timofte1,
Institute, Bucharest, Romania
2
University of Medicine and Pharmacy Carol Stefan Dumitrache-Rujinski2
3
Hpital Piti Salptrire, Universit Pierre et Davila, Bucharest, Romania
Marie Curie, France 2
Institute of Pulmonology Marius Nasta,
Bucharest, Romania
Non-alcoholic fatty liver disease (NAFLD) and
chronic kidney disease (CKD) shared common Objectives: IFNy is a soluble cytokine from
features, such as type 2 diabetes mellitus, meta- the II class of interferons. It is critical for the native
bolic syndrome, obesity and insulin resistance. immunity and adaptation against viral and bacte-
The aim of the study was to assess the risk fac- rial agents, by inhibiting the viral replication and
tors for CKD in patients with NAFLD. stimulating the macrophages inducing the MH-
We enrolled consecutive patients with histo- CII. The Il1, Il12 macrophages surround the Th
logical proven NAFLD. Clinical and biological cells and become Fibroblasts-like resulting into
data were recorded at the time of liver biopsy. the appearance of granuloma.
CKD was defined as eGFR 2.7. IBM SPSS Statis- Methods: The patient, 58 years old, female,
tics 21 programme was used to analyze data. non-smoker, with professional exposure (carpet
75 patients with liver biopsy proven NAFLD factory)-10 years, diabetic was treated for Hepa-
were included: mean age 54.3 9.9 years, titis C with IFNy (2007-2008) and restarted in
57.3% men. CKD was present in 15 (20%) of 75 2015 presents with progressive dry cough for over
NAFLD patients. 74.7% of patients presented a year. The clinical Examination depicts normal
metabolic syndrome, 57.3% type 2 diabetes mel- breath sounds and saturation of oxygen, with no
litus, 65.3% arterial hypertension, 58.4% obesity peripheral adenopathies or hepatosplenomegaly.

ABSTRACTS
The complete blood count discovered a mi- multiple myeloma could be the hidden cause in a
nor leucopenia and inflammatory syndrome. X- patient with chronic kidney disease.
ray shows enlarged pulmonary hila and superior Methods: A 71-year-old female, known with
mediastinum, CT reveals mediastinal adenopa- essential hypertension (stage II), chronic kidney
thies and nodules (0.9-1.5cm). disease, coronary heart disease,and chronic heart
Diferential diagnostic is made between: HVC failure. She presents to the emergency depart-
associated vasculites, sarcoidosis, lymphoma and ment with: nausea, rib cage and lower back pain,
adverse reaction from the IFNy treatment. with radiation to the hip joint. Clinical examina-
Further investigations: ACS-normal, HIV- nor- tion revealed: hypertension (160/80mmhg), ven-
mal endobronchial aspect, bronchoalveolar la- tricular rate (88 bpm), basal spontaneous pain on
vage with no tumoral cells, no bacteria, and dis- palpation of the left hemithorax. Laboratory in-
crete lymfocytosis, functional pulmonary explo- vestigations revealed: hypercalcemia (13.21 mg/
rations are also normal. dl), elevated total protein (14.16 mg/dl), elevated
The ganglia biopsy describes: granulomatous Blood Urea Nitrogen (75 mg/dl), elevated creati-
nodules without caseous necrosis. nine (4.27 mg/dl), elevated amylase (150 u/l), hy-
Results: The entire Clinical-Paraclinical con- ponatremia (133 mmol/L), hypokalemia (2
text indicates a case of secondary sarcoid-like re- mmol/L), hypoalbuminemia (2.5 g/dl), mild nor-
action after the IFNy treatment. mocytic normochromic anemia with hemoglobin
The Patient continued the treatment due to (9.1). Before making the diagnosis, the patient
the importance of reaching an undetectable vire- was hydrated and perfused in order to normalize
mia and the fact that the respiratory function was both values of hypokalemia and hyponatremia.
intact. Also, the patient was treated for hypercalcemia.
The reevaluation after finishing successfully Blood pressure and ventricular rate were also
the IFNy treatment, the CT shows a normal as- maintained at normal level. The pain was amelio-
pect, with the retraction of the previous nodules. rated with analgesics.
Therefore the diagnosis of Sarcoid-like reaction Results: Suspected multiple myeloma was
from the IFN treatment is confirmed. supported by laboratory investigation showing:
Conclusions: In choosing the right approach hypercalcemia and hyperproteinemia,seric pro-
of a patient with such unspecific clinical and ra- tein electrophoresis, cranial X-ray revealing mul-
diological manifestation, the physician should tiple zones of osteolysis in the frontal, occipital
also take into consideration this possible side-ef- and temporal bones, expression of Bence Jones
fect of the IFNy treatment and decide the balance Proteins in the urine strengtened by positive
of continuing or stopping it. medullary puncture.
Conclusion: Patient known with chronic kid-
(304) Multiple myeloma: a ney disease, aggravated by a chronic intake of
NSAIDs due to bone pain. Investigations revealed
possible hidden cause of hyperproteinemia and hypercalcemia. The final
chronic kidney disease diagnosis was made on the bases of the cranial
radiology, presence of Bence jones proteins in
Anca Diana Mitan, Alin Florin Catrina, urine and bone marrow puncture.
Elena Florinela Gligore, Angela Maria
Ivan, Alfa Abdulkareem Imam, Maria (305) Arrhythmogenic risk
Daniela Tanasescu and severity of coronary
University of Medicine and Pharmacy Carol arteries injuries
Lucia Maria Roatesi
Objectives: Multiple myeloma represents the University of Medicine and Pharmacy Carol
malignant proliferation of plasma cells in bone Davila, Bucharest, Romania
marrow with the production of monoclonal para-
proteins. These plasmocytes release substances Objectives: This paper aims to describe the
that produce bone lysis with consequent bone spontaneous cardiac arrhythmias encountered in
pain. Paraproteins are light chains of immuno- patients with coronary artery disease (CAD) with
globulins which precipitate and produce the al- significant injuries, proven by angiography and to
teration in physiologic renal function. The aim of compare these arrhythmias with those found in a
this study is to aid in the early diagnosis of multi- group of patients without significant CAD.
ple myeloma and to demonstrate the fact that

ABSTRACTS
Method: This study is a retrospective study thromboembolism (VTE). Extensive screening of

which included 80 patients with stable CAD, cor- cancer in patients with unprovoked VTE is not
onary anatomy assessed by coronary angiography widely recommended. The main purpose of our
or MSCT, and the presence of cardiac arrhyth- study was to determine weather the high RDW
mias by ECG Holter. level could be a new bio-marker of the presence
Results: In this study we included 80 patients, of cancer in patients with VTE.
60 men and 20 women, compared 3/1. Observe Methods: we prospectively evaluated 100 pa-
the predominance of men in the study group and tients admitted consecutively in our clinic with
also of the age group 60-69 years. the diagnosis of deep vein thrombosis (DVT) and
The biochemical and metabolic alterations / or pulmonary embolism (PE). Patients were di-
caused by I/R phenomena are responsible for vided in the two study groups: group A- 60 pa-
electrofiziological inhomogeneity favoring arth- tients without cancer (excluded by extensive
mogenesis conditions. These complex changes screening methods including mammography and
represent an arrhythmogenic substrate in differ- abdomino-pelvin CT scan) and group B- 40 pa-
ent cardiac structures. tients with cancer (70% with known malignan-
Analyzing the results is observed complex cies, 30% having VTE as the first sign of malig-
ventricular arrhythmias in patients with significant nancy).
injuries: presence of ventricular doublets (p = Results: There were no significant differences
0.00003) and non-sustained ventricular tachycar- regarding sex distribution between the two groups
dia (NSVT) (p = 0.00002) in these patients. (60% in both groups). PE was present in 15% of
It can be noted also that patients with three- patients in group A and 25% of those in group B.
vessel injuries show an increased incidence of There were statistically significant differences be-
non-sustained injuries to those two-vessel inju- tween the two groups (group A vs. group B) in
ries, from 2% to 18%. terms of age (59.56 16.46 vs. 66.16 10.24
Conclusions: The study highlights the associ- years, p = 0.011), hemoglobin level (13.05
ation noninvasive Holter ECG with invasive angi-
2.44 mg/dl vs. 10.59 2 mg/dl, p = 0.005) and
ographic to emphasize the link between the se-
ESR (18.53 8 mm / 1h vs. 42.13 17.2, p =
verity of coronary injuries and the severity of
0.002). RDW was significantly higher in patients
cardiac arrhythmias, enabling the assessment of
with malignancies compared with those who had
patients with arrhythmias. The incidence and se-
no diagnosis of cancer (14.49 2.61 vs. 12.38
verity of cardiac arrhythmias is greater as coro-
1.98%%, p = 0.0006).
nary injurys are more severe and include several
Conclusion: The presence of elevated levels
major coronary arteries.
of RDW, along with other clinical and hemato-
The study allowed the delimitation of the
logical markers already validated, as older age,
CAD arrhythmogenic profile, characterized by
complex cardiac arrhythmias with hemodynamic anemia and inflammation requires a thorough
impact and associate this profile with severity of screening to rule out a malignancy in patients
coronary injuries (degree of stenosis). with unprovoked VTE.
(306) High red blood cell (308) Bone assessment

distribution width could be improvement on primary
a marker of cancer in hyperparathyroidism: focus
patients with unprovoked on Trabecular Bone Score
VTE Nicoleta Dumitru1, Anda Dumitrascu1,
Andrei Goldstein1, Mara Carsote2,
Roxana Siliste1, Ioana Zarcu1, Raluca
Dumitru Ioachim1, Ana Valea1, Dana
Ciomag2, Corina Homentcovschi2
Terzea2, Adina Ghemigian1
1
Davila, Bucharest, Romania University of Medicine and Pharmacy Carol
2
Department of Internal Medicine and Davila, Bucharest, Romania
2
Cardiology, Coltea Clinical Hospital, Bucharest, National Institute of Endocrinology C.I.Parhon,
Romania Bucharest, Romania
Objectives: An occult cancer is diagnosed in Objective: Trabecular Bone Score (TBS) rep-
10% of patients with an unprovoked venous resents the latest tool to assess the skeletal archi-

ABSTRACTS
tecture based on prior lumbar DXA (Dual-Energy (311) The impact of the
X-Ray Absorptiometry) capture. TBS iNsight soft-
ware is attached to central DXA machine and treatment in acute
provides the indices. A new bone perspective is pericarditis
offered which is the first available for current
practitioners knowing that prior similar studies us- Georgiana Elena Savu1, Daniela Pitic2,
ing quantitative computed tomography or bone Cristina Teodorescu2
morphometry are recommended only for clinical 1
trials. We aim to focus on TBS changes as well as Davila, Bucharest, Romania
classical bone features on a subject treated for 2
Floreasca Emergency Hospital, Bucharest,
primary hyperparathyroidism (PHPT). Romania
Method: Bone Mineral Density (BMD) is
based on GE Prodigy DXA device, providing Z- We present the case of a 64 years old pacient
score according to WHO criteria. Phosphor-calci- with medical history of gastric ulcer, esofagitis,
um metabolism is tested using parathormone hipertension and pericardial effusion (05.2015)
(PTH), 25-hydroxyvitamin D (25-OHD). The pa- who was admitted to the hospital with fatigability
tient signed the consent to use her medical re- and one episode of loss of conscioussness. He
cords on March2016 also presented cough and fever by a week. On
Results: A 43-year old menstruating female admission he has no signs of ventricular failure or
was diagnosed 8 years with PHPT starting from haemodinamic disorder. The clinical examination
multiple fragility fractures as vertebral, rib, and was aparrently normal, without any murmurs or
clavicle. She came for an endocrine check-up pericardial friction rub. (TA=128/80 mmHg;
since she associated persistent high levels of cal- AV=90 bpm, without oedema). Biologically he
cium. On admission, a high PTH values (more had leucocitosis with limfocitosis and increase in
than 10 times above the upper normal limit), high the inflamatory markers; no increase of cardiac
bone remodeling markers and a 25OHD of 4 ng/ necrosis markers. Electrocardiography showed a
mL (normal >30 ng/mL) indicated a secondary negative T-wave in DIII, aVF, V1-V6. Computer
and a primary activation of parathyroid glands. tomography of the chest demonstrated pericar-
Sustained vitamin D supplements were offered to dial effusion. Ecocardiographic examination es-
the patient for a few months and then left supe- tablished the diagnosis and reveals a moderate
rior parathyroidectomy was performed. Treat- diastolic disfunction in progression.
ment with alendronate weekly was added for 5 The most patients with small and medium
years. After surgery, no hypoparathyroidism was pericarditis can be managed effectively with
registered; she never experienced any new frac- medical therapy. Non steroidal antiinflamatory
ture while PTH and 25OHD remained normal. drugs are the mainstay level of evidence B, class I.
L1-4 lumbar BMD of 0.484 g/sqcm, Z-score of Colchicine added to the NSAID or as monoterapy
-5.7SD increased after 5 years to L1-4 BMD of also appears to be effective for the attack and the
1.047 g/sqcm, Z-score of -0.4SD, L1-4 TBS of prevention of a recurrence (level of evidence B,
1.41 and 3 years later of holiday drug DXA class IIa indication).
showed similar results while TBS pointed a con- In this case, the treatment with NAINS was
tinuous augmentation to L1-4 TBS of 1.555. initiated (3g Ibuprofen per day) and the patient
Conclusion: TBS analyze data are limited for has developed upper gastrointestinal bleeding;
the calculation obtained on Romanian medical the upper endoscopy reveald active gastric ulcer
centers since the method is new. After the correc- so the Ibuprofen was stoped; that is the reason
tion of PTH and anti-osteoporotic therapy, TBS why he will receive only 1mg colchicine per day.
might become a more useful tool to reflect the The clinical evolution, was improuved, the fe-
bone recovery than BMD-DXA especially in non- ver, cough and fatigability were submitted.The
menopausal women. patient was discharged receving 1g of Colchicine
par day, Esomeprazole for the gastric ulcer and
the hypertension treatment.
After one month echocardiography shows
pericardial deposits of fibrine that reveals a pos-
sible evolution to a constrictive pericarditis. In this
case the medical treatment, impose by the other
pathologys, is apparently innefective as the evolu-
tion of the disease may be cronic.

ABSTRACTS
The particularity of this case is that it refers to Conclusions: We consider that a nearly fol-
one patient with pericadial effusion, who cant low-up of women with breast cancer risk factors,
receive the standard treatment with NAIND and can lead to an earlier correct diagnostic and treat-
is treated only with colchicine. Colchicine cant ment of those patients, and it could reduce mor-
replace the benefic effects on the acute inflama- tality in young breast cancer patients.
tion of the NAIND. That was demostrated by the
evolution of the desese. (315) Influenza and
seasonal influenza caccine
(314) The importance of
where do we stand?
breast cancer risk factors in
prevention and early Andreia Florina Nita, Mihaela Roxana
Huhu, Dragos Paul Hagiu, Madalina
diagnostic
Preda, Octavian Ioghen, Gabriela
Diana Bunescu1, Gabriela Lupusoru2, Loredana Popa, Mircea Ioan Popa
Mihaela Banu2, Lucian Negreanu2, University of Medicine and Pharmacy Carol
Dumitru Ferechide2, Adrian Barbilian2, Davila, Bucharest, Romania
Mircea Lupusoru2
1
Floreasca Emergency Hospital, Bucharest, Since 1960s Influenza Vaccine is available for
Romania use in Europe, making the influenza a vaccine
2
University of Medicine and Pharmacy Carol preventable disease.
Davila, Bucharest, Romania Objectives: To evaluate the knowledge and
attitude regarding influenza viruses and seasonal
Background: Breast cancer is the most com- influenza vaccines in general population.
mon malignancy in women of our country. There Methods: We designed a questionnaire with
are several risk factors presumed to be related several sections: personal information and influ-
with breast cancer and his incidence in young pa- enza notions - with 13 multiple choice questions.
tients, based on data from many studies. The aim Between 5th of April 2015 and 10th of April we
of this study was to evaluate breast cancer staging posted the online version of the questionnaire on
and to find out which of those presumed risk fac- several public websites and asked the visitors to
tors are relevant for our breast cancer patients. answer the questions. There were 169 partici-
Methods: we have performed a retrospective, pants to the study, out of which we excluded 67
descriptive and observational study, on a lot made of persons as they were part of medical person-
up to 102 patients with breast cancer, evaluated nel. Data collected has been processed using Epi
and treated in the Oncology ward of the hospital Info 7.
Titan Dr. Constantin Gorgos, Bucharest. Results: Almost 80% of participants were fe-
Results: For statistic analysis we used the fol- males, 90% coming from urban area. More than
lowing software: Excel and SPSS and we aplied 90% of the participants knew about the existence
especially nonparametrical tests and multiple of influenza vaccine, 83.6% think that the flu can
comparison tests. 92 patients (90%) were from be prevented, and 77.2% believe that vaccina-
urban areas, 52 patiens have not breastfed (51%) tion can prevent it. More than 25% of participants
and 38 patiens were nulliparous (37%). Benign consider that the influenza cannot be fatal, while
mamar disease was present in the medical history half of the participants are afraid of getting the flu.
of 22 patients (22%) and benign genital disease in Only 5 persons got vaccinated this season,
other 22 patients (22%). Statistic analysis showed 52% consider it healthier to get immunity by
a significant relation between incidence of breast passing through disease while 30% declared as
cancer and a number of risk factors as: urban ar- anti-vaxxers. There were 6 participants who
eas, benign breast disease, benign genital disease, wanted to get vaccinated, out of which in 4 cases
the absence of breast feeding, nulliparous status the general practitioner was out of vaccines, and
or age after 30 years for the first birth (p<0,001). 2 participants could not find the vaccine in phar-
Only 2% of the patients were diagnosed in stage macies.
0, while the majority of patients were diagnosed Almost 78% of participants have never got
in stage II 44 patients (43%) and in stage III 28 vaccinated against influenza and only a quarter of
patients (27%). The lack of prevention, early de- respondents consider that at the time of the study
tection and follow-up are responsible for the high there was influenza epidemic in Romania.
incidence of locally advanced breast cancer.

ABSTRACTS
Internet seems to be the most frequent source (335) Extremes in

of information used, as 88.5% get informed about
influenza from internet, compared to friends hyperparathyroidism:
-55.7% and TV 37.5%. management of parathyroid
Conclusions: In the time of influenza epi-
demic in Romania, only 5 persons got vaccinated,
carcinoma
this fact being due not to a lack of vaccine avail- Lidia Radomir1, Daniel Mihai1,
ability, but to a lack of knowledge most of the Simona Jercalau1, Adriana Gogoi1,
participants did not even try to get vaccinated, as
they consider that immunity is better acquired
Alina Nastase1, Corin Badiu1,2
1
through getting ill. National Institute of Endocrinology C.I. Parhon,
Bucharest, Romania
2
(327) Superficial basal cell University of Medicine and Pharmacy Carol
carcinoma of the trunk
Background: Parathyroid carcinoma (PC) is a
Laura Ioana Coman rare cause of primary hyperparathyroidism
University of Medicine and Pharmacy Carol (PHPT), accounting for less than 1%, with an
Davila, Bucharest, Romania equal gender distribution and an average age of
diagnosis in the fifth decade of life. The diagnosis
Objective: Basal cell carcinoma (BCC) is the of PHPT is based on the laboratory finding of high
most common skin malignancy. Its incidence has levels of immunoreactive PTH in the presence of
increased in the past 20 years, representing 30% severe hypercalcemia. The only potentially cura-
of the total cutaneous malignant tumors and 68- tive treatment for PC is surgery. Early surgery is
80% of cutaneous epithelioma. the most important factor for optimal outcome.
Method: We present the case of COA, 52 Methods: This case series is based on a multi-
years old, with no significant pathologic anteced- disciplinary review of four patients with parathy-
ents, type IV Fitzpatrick, with constant 2 week/ roid cancer, describing their therapeutic manage-
year sun exposure with photo-protection creams. ment and follow-up. Imagistic evaluation was
About 3 years ago she observed a pigmentary performed by ultrasound (US), computed tomog-
maculae on the lower back trunk, which re- raphy scan (CT), magnetic resonance imaging
mained unchanged until last month, when the (MRI), positron emission tomography (PET) and
Technetium-99m sestamibi scintigraphy, for de-
patient observed accidentally a fine pigmentary
tecting the primary tumour, its local extent and
asymmetrical extension with an almost impercep-
remote metastases.
tible discoloration of the center of the lesion.
Results: Between 2008 and 2014 four pa-
Clinical and dermatoscopic examination suggest-
tients were diagnosed with PC in our clinical de-
ed the diagnosis of BCC, so surgical excision fol-
partment, three men and a woman, with a mean
lowed by histopathology examination were per- age of 50 years SD 13.22 (range 38-68). None
formed. had family history of hyperparathyroidism or hor-
Results: Histopathology examination con- monal disorders suggesting multiple endocrine
firmed the clinical diagnosis of superficial BCC ( neoplasia. All had severe hypercalcemia (15.3-
normal orthokeratotic epidermis, tumor masses 19.4 mg/dl) and elevated PTH levels ranging from
of basal type cells, lymphocyte infiltrate and me- 15 to 45 times above normal value. Tumour size
lanic pigment at the dermo-epidermic junction). ranged from 3.2 to 7 cm; two of them had thy-
Conclusion: Relative low age of onset, rare roid gland invasion and one thymic invasion.
localization on the lower back, which is less sun- Three patients underwent parathyroidectomy
exposed, slow evolution without ulceration, but with hemithyroidectomy and one underwent
with asymmetrical pigmentation. Repeated sun parathyroidectomy with thymectomy and cervi-
exposures, even sun burns in childhood and cal dissection. Schulte stage at diagnosis was be-
teenage, might be incriminated in the pathogen- tween II and IV, while all were classified as high
esis of this BCC. risk. Conformational radiotherapy of the tumour
bed was used in 2 cases. Cinacalcet treatment
was tried in one case and chemotherapy regimen
in another, without significant improvement.
Three patients had local recurrence and the time
from the initial surgery to recurrence ranged from
1 month to 1 year.

ABSTRACTS
Conclusion: Parathyroid carcinomas are rare fractory disease. Regarding consolidation therapy:
endocrine cancers, with high relapse rate and 20% patients received HIDAC regimen; 13.33%
poor prognosis. Multidisciplinary approach re- patients IDAC; the remaining patients are still un-
quires detailed imaging, skilled surgeons, endo- dergoing chemotherapy protocol. Twenty percent
crinologist and oncologist. are proposed for allotransplantation of hemato-
poietic stem cells.
Conclusions: These results underline the im-
(340) The impact of portance of cytogenetic and molecular tests in the
cytogenetic and molecular risk classification and therapeutic decisions in
analysis on survival in AML patients. These tests must be part of investi-
gations mandatory for all patients with acute leu-
patients with acute myeloid kemia.
leukemia
Mihaela Cirstea, Bogdan Ionescu, (348) Clivus chordoma
Didona Vasilache, Cerasela Jardan, a rare sellar mass
Mihaela Dragomir, Camelia Dobrea, mimicking pituitary
Anca Gheorghe, Daniel Coriu adenoma. Long-term
Fundeni Clinic Institute, Bucharest, Romania follow-up
Objectives: Acute myeloid leukemia (AML) is Antonia Lefter1, Serban Radian1,
the most common acute leukemia in adults. It is Ionut Gobej2, Radu Tanasescu1,
widely accepted that the use of cytogenetic and Cristina Capatina1, Catalina Poiana1,2
molecular tests help classify these patients into
1
risk groups. This allows a risk adapted therapy. In University of Medicine and Pharmacy Carol
this study we aimed to analyse the impact of cy- Davila, Bucharest, Romania
2
togenetic and molecular abnormalities on survival National Institute of Endocrinology C.I. Parhon,
from 30 newly diagnosed patients with AML. Bucharest, Romania
Materials: A study of 30 patients diagnosed
with AML in the period January-July 2015 in the Objectives: Chordomas are rare, slow-grow-
Center of Hematology and Bone Marrow Trans- ing malignant bone tumors arising from noto-
plantation Fundeni Clinical Institute. chord remnants. Skull base chordomas may cause
Methods: Cytomorphology/ cytochemistry / severe cranial nerve palsies and are life threating
bone marrow biopsy/Immunophenotyping/ Cyto- due to brainstem proximity. Perisellar chordoma
genetic exam / FISH and and molecular biology can rarely present as a sellar mass, as illustrated
by Multiplex PCR identification (AML1-ETO; by our patient.
FLT3-ITD; MLL-AF9; PML-RARa; CBFb-MYH 11) Methods: A 47 years old female patient pre-
/ Real - Time PCR (AML1-ETO; PML-RARa; CBFb- senting with left VIth cranial nerve paralysis was
MYH 11). evaluated clinically, with repeated imaging and
Results: 30 cases of AML: 46.66% men, underwent several surgeries and proton beam ir-
53.33% are women. The median age is 50.66 radiation. Surgical specimens were evaluated his-
years. According to FAB classification: 13.33% tologically and by immunohistochemistry.
patients AML0; 16.66% AML1; 3.33% AML2; Results: Initial assessment revealed early
6.66% AML3; 26.66% AML4; 20% AML5. Eight menopause (45 years), appropriately high serum
patients presented normal karyotype; 2 patients gonadotropins and increased prolactin levels (50
trisomy 9; 2 patients t (15; 17); 2 patients t (8; ng/mL), inconsistent with prolactinoma. Insulin
21); 1 patient inv 9; 5 patients unconclusive cyto- tolerance testing revealed normal corticotroph
genetic; for 9 patients has not been evaluated. and somatotroph function and cerebral IRM re-
Two patients present PML / RAR; 1 patient with vealed a sellar and suprasellar mass, which was
S isoform (bcr-3) associated FLT3-ITD mutation; 2 removed transsphenoidally. Histological exami-
patients AML-ETO; 2 patients FLT3-ITD; 1 patient nation revealed a sellar chordoma with positive
CBFb-MYH11, 18 patients without molecular ab- immunohistochemistry for cytokeratin PAN (KL
normalities. According to NCCN guidelines: 1), Ki-67 index 3-4%, high co-expression of vi-
13.33% patients favorable risk; 26.66 % patients mentin/ S100 protein. After a first tumor relapse,
high risk; 60% intermediate risk. Fifty percent pa- treated by transsphenoidal surgery, proton beam
tients achieved complete remission; 16.66% pa- therapy (74 Gy) was administered to the sella and
tients partial remission; 3.33% patients had re- clivus. Repeated tumor recurrences led to six sur-

ABSTRACTS
gical procedures (transsphenoidal/ transtemporal) The evaluation took into account the charac-
over eight years. Throughout follow-up, pituitary teristics of type age (under or over 45 years), tu-
function was preserved, with only mild gonado- mor stage (pTNM), histological subtype, vascular
tropin insufficiency. Low IGF-I levels, noted re- invasion, lymphatic and regional and extra thyroi-
cently, may indicate somatotroph insufficiency or dal extension of the primary tumor.
GH resistance due to malnutrition (diagnostic ITT This study found a correlation between higher
was deemed too invasive). Multiple cranial nerve prevalence of BRAF V600E gene mutation and
palsies developed: IX and X (dysphagia, leading unfavorable prognostic factors: the absence of tu-
to feeding impairment and right vocal cord), III- mor capsule, pT3 / pT4, advanced stages (III and
partial and VI (bilateral ocular paralysis), V and VII IV), invasion of lymphatic vessels, extra thyroidal
(right facial paralysis and hypoesthesia). Tumour invasion. Also, although without reaching statisti-
resection to decompress cranial nerves was per- cal significance, the study found the association
formed after initial treatment of atlanto-occipital of a higher prevalence of BRAF V600E mutation
instability by fixation with titanium rods. Swallow- with vascular invasion, with feminine and with a
ing and phonation were significantly improved, 45 years of age.
and immediate postoperative control CT showed Conclusion: BRAF V600E mutation repre-
approximately 80% reduction of tumor volume. sents a factor of alert for a closer look and follow
After postoperative recovery, radiotherapy is pla- a more aggressive antitumor therapy.
nned, to stabilise disease progression. Molecular
tumor profiling revealed negative c-kit (CD117)
staining and presence of p.G719S EGFR muta- (350) Age estimation in
tion. Tyrosine kinase inhibitors (e.g. Imatinib) may subadults based on the
also slow progression.
Conclusions: Treatment of chordoma pati-
parameters of
ents is difficult and requires multidisciplinary anthropological analysis
care, with an overall poor prognosis. The main of the thigh length
focus of therapeutic endeavors is to improve qua-
lity of life and prolong survival. Antoaneta Punga1, Mariana Rosu2,
Mircea Lupusoru1, Anca Badarau1,
(349) Prevalence of the Adina Lungu3
mutation of BRAF V600E 1
gene in differentiated 2
National Institute of Legal Medicine Mina
thyroid cancer: anatomo- Minovici, Bucharest, Romania
clinical correlations 3
Romania
Mirela Diana Ilie1, Ruxandra Dobrescu1,
Andrei Goldstein1, Dumitru Ioachim1, Objective: In Romania, the age estimation for
Corin Badiu2 a living person is performed on a working proto-
col derived from the rules developed by the Study
1
National Institute of Endocrinology C.I. Parhon, Group for Forensic Age Diagnostics. According to
Bucharest, Romania this, the investigation methods to be used are:
2
University of Medicine and Pharmacy Carol physical examination to determine some
Davila, Bucharest, Romania anthropometric measures (weight, height,
constitutional type, sexual maturation,
Objective: Thyroid cancer is the most com- identification of diseases that would cause
mon endocrine cancer and represents about 1% the abnormal development of the body).
of all cancers. In addition, its incidence is on the Methods: The study was conducted on 181
rise, with the fastest growing cancer incidence forensic cases which required an anthropological
among women and No. 2 among men. forensic exam so as to estimate the age in sub-
In this study included 56 patients operated on adult individuals (under 13 years old). The study
for differentiated thyroid cancer, undergoing radi- included 93 females and 88 males. For each pa-
uoterapiei with iodine-131 and receiving BRAF rameter, a linear regression equation for males
V600E mutation resulted presence in the Labora- and respectively females was created. The adjust-
tory of Molecular Biology of the National Institute ed R2 values for the equations created based on
of Endocrinology C.l. Parhon Bucharest. the above parameters were in all cases over 0.5;

ABSTRACTS
the highest values were obtained, in the case of transmission aggregometry were evaluated at
both sexes, for the thigh length. baseline and after one month.
Results: Based on the regression equations Results: At baseline SUA level (p=.22), plate-
obtained for age estimation from general anthro- let count (p=.10) and platelet aggregation to ADP
pometric parameters we can create algorithms (p=.19) and collagen (p=.23) were similar in the
either in Excel or programming languages which two groups. After one month of treatment, in
may allow, in many cases, to identify the age with ALLO+ group there was a significant decrease in
a margin of error of a few weeks. SUA level, from 5.61.9mg/dl to 3.31.5 mg/dl
Conclusions: By introducing all of the vari- (p=.0003) and in platelet aggregation to ADP,
ables analysed above in a regressive matrix and from 7716% to 3824% (p=.0009) and to col-
using the stepwise method to eliminate variables, lagen from 8714% to 7121% (p=.0002).
the following polynomial regression equations Platelet count remained constant (p=.48). At
were obtained: baseline pts with ASA had a lower level of aggre-
For females: Age = 0.413*Length (cm)+ gation to collagen. After a month, in ALLO+
0.432*Thigh length (cm) - 5,866 which group the decrease in collagen aggregation was
has an adjusted R2 of 0.817 more important in pts without ASA (p=.0004)
For males: Age = 0.450*Length (cm)+ compared to pts with ASA (p=.003). The de-
0.101* Thigh length (cm) -7,019, which crease in platelet aggregation, both to ADP (r=-
has an adjusted R2 of 0.744. 0.25, p=.35) and collagen (r=-0.15, p=.59) did
not correlate with SUA decrease. In ALLO- group
(351) Allopurinol effect on there were no significant variations of aggregation
to ADP (p=.06) and collagen (p=.34), of SUA
platelet aggregation in (p=.49) or platelet count (p=.34).
patients with essential Conclusion: ALLO has an antiplatelet effect
by inhibiting platelet aggregation to ADP and col-
hypertension lagen, independent of its effect of lowering SUA
Andreea Simona Hodorogea, Alexandru and does not affect platelet count.
Campeanu, Valentina Uscatescu,
Adriana Mihaela Iliesiu, Ioan Tiberiu (353) Simple, usual
Nanea parameters, as alarm
University of Medicine and Pharmacy Carol signals in childhood obesity
Bogdana Virgolici, Laura Anca Popescu,
Background: The increased level of serum Daniela Casariu, Daniela Lixandru,
uric acid (SUA) could affect platelet function, an Daniela Miricescu, Horia Virgolici,
important mechanism in the progression of car- Dumitru Oraseanu, Maria Mohora
diovascular disease (CVD). Allopurinol (ALLO)
has beneficial effects in patients (pts) with CVD, University of Medicine and Pharmacy Carol
but its mechanisms of action have not been fully Davila, Bucharest, Romania
elucidated yet and its effect on platelet function
has not been studied until now. Childhood obesity is asociated with insulin re-
The purpose of the study was to evaluate the sistance, oxidative stress and with dyslipidemia.
effects of ALLO on platelet aggregation in pts with The aim of this study is to underline that strong
essential arterial hypertension (AH) in relation correlations between cheap and usual parame-
with its SUA lowering effect. ters with those important markers known to be
Methods: 70 pts with AH were included, modified in obesity, but the measurement of
mean age 6212y ears, 54% women, mean these markers is expensive.
blood pressure/24 hours on ambulatory monitor- The study was done on 110 overweight and
ing 13312/808 mmHg with antihypertensive obese children, aged 10-18 years, at whom usual
treatment. 31pts were treated with acetylsalicylic clinical parameters were measured and also some
acid (ASA). In 37 pts ALLO 300 mg/day was add- important, but less common variables like: C
ed to the therapeutic regimen, regardless of the peptide, HOMA-IR, total antioxidant capacity
SUA level (ALLO+group). In all pts SUA level, (TEAC), malonyldialdehide (MDA), glutatione
platelet count and platelet aggregation to adenos- (GSH), carotid intima media thickness (CIMT), su-
ine diphosphate (ADP) and collagen by the light peroxid dismutase (SOD) and serum cortisol.
There were chosen significant and strong correla-

ABSTRACTS
tions for the folowing parameters: waist circum- (95%CI: 68.01%-78.98%) were incompletely im-
ference, uric acid, total bilirubin, ALT activity and munized, 58.27% (95%CI: 52.23%-64.13%) had
cholesterolemia. at least one respiratory infection during their life-
The waist circumference was correlated with time, and 37.41% (95%CI: 31.70%-43.39%)
surrogat markers of insulin resistance, HOMA-IR were diagnosed at the time of admission with re-
(r= 0,40), with C peptide (r= 0,45) and also with spiratory infection. The correlation coefficient be-
CIMT (r= 0,59) and with cortisol (r= 0,43). Total tween respiratory infections and the following
bilirubin was correlated with TEAC (r=0,55), uric characteristics was of -0.0002 (p=0.6531), with
acid with C peptide (r=0.60) and with TEAC an odds ratio of 0.9998 (95%CI: 0.9989-1.0007)
(r=0,65), cholesterolemia with MDA (r= 0.30), for the childs weight at birth; of -0.3319
and ALT with GSH (r= -0.34) and SOD was nega- (p=0.5901) with an odds ratio of 0.7176 (95%CI:
tively correlated with glycaemia (r= -0.30) and 0.2145-2.4002) for premature birth; of -0.6910
positively correlated the albumin/globulin ratio (p=0.1800), with an odds ratio of 0.5011 (95%CI:
(r= 0,39). 0.1825-1.3760) for complete immunization; of
In conclusion, in obese children, the increased 0.7874 (p=0.0654), with an odds ratio of 2.1977
uric acid and waist circumference values were (95%CI: 0.9512-5.0780) for smoke exposure; of
correlated with insulin resistance. Uric acid and -0.0495 (p=0.3114), with an odds ratio of 0.9517
total bilirulin levels were associated with total an- (95%CI: 0.8646-1.0475) for the mothers studies;
tioxidant capacity and the high level of ALT and of -0.0459 (p=0.2009), with an odds ratio of
of cholesterol with an increased oxidative stress. 0.9552 (95%CI: 0.8904-1.0247) for the mothers
Simple, usual parameters at the edge of the age.
normal range can underline the presence of an Conclusions: The results of this study suggest
antioxidant-oxidant imbalance. that complete immunization, higher maternal
educational level and greater age were associated
(354) Risk factors for with a reduced risk of the infant developing respi-
respiratory tract infections ratory infections. Conversely, small birth weight
and cigarette smoke exposure of the infant in-
in infants creased the risk of respiratory infection.
Mircea Ioan Popa1, Mihaela Stefanescu1,
Luiza Maria Butoi1, Octavian Ioghen2, (357) The difference
Madalina Preda1, Doina Anca Plesca1 between the severity scores
1
University of Medicine and Pharmacy Carol and biological markers of
Davila, Bucharest, Romania infection in sepsis with
2
Childrens Clinical Hospital Dr. Victor Gomoiu,
Bucharest, Romania Enterobacteriaceae and
other Gram-positive cocci
Objective: The purpose of our work was to
observe the correlations between the infectious Aida-Isabela Adamescu1, Sebastian
respiratory pathology in infants and various fac- Ciobanu, Alina Orfeanu, Dorin Dragos,
tors related to the mother or the infants medical Cristina Popescu
history.
Methods: We retrospectively studied a num- INBI Prof. Dr. Matei Bals, Bucharest, Romania
ber of 278 infants, aged between 2 days and 1
year, admitted between August 1st and October Objectives: The primary objective of this
31st 2015 to the Dr. Victor Gomoiu Clinical study was to describe whether the severity scores
Hospital. Using Epi Info 7.1.5.2 we determined and the biological markers of infection and in-
frequencies of various characteristics and through flammation are more altered in Enterobacteria-
applying logistic regression we analyzed correla- ceae infections compared to infections with other
tions between respiratory infections on one hand families of bacteria (especially Gram-positive co-
and the childs birth weight, preterm birth, in- cci).
complete immunization, cigarette smoke expo- Methods: Student T and Chi square tests
sure, maternal educational level and age on the were used to analyze data from 77 patients with
other. sepsis who were admitted to Prof.Dr. Matei Bals
Results: Of the 278 infants, 11.72% (95%CI: National Institute for Infectious Disease during
8.16%-16.4%) were prematurely born, 73.76% 2015-2016.

ABSTRACTS
Results: Both APACHE and APS scores seem allowed pediatric surgeon or urologist to make a
to be significantly higher in patients with Klebsi- rapid diagnosis, early and accurately and deter-
ella infections, but there were few cases to draw mine the best therapeutic approach, knowing
conclusions. Putting together all the patients with that any abnormality should be treated as early as
Enterobacteriaceae infections (77 patients) re- possible because the sequelae will not be so seri-
vealed significantly higher APACHE (the highest ous
values being 2.94,2.84.3.07 )and APS scores in Method: In this study were included patients
this category. There was also a significantly higher diagnosed with anomalies of the male genital ap-
MPV in Escherichia coli patients as well as in the paratus and admitted to hospital M.S.Curie in
Enterobacteriaceae patients. The PCT was signifi- 2012-2014.
cantly higher (highest-1.65) in Klebsiella patients, Results: Most patients were diagnosed with
which also stands true for the whole Enterobacte- abnormalities of the testicle, and of these the
riaceae group, but without reaching statistical sig- most frequent was the undescended testicle uni-
nificance. Significantly PCR levels are associated laterally. Second place after testicular malforma-
with digestive, respiratory and skin infections, but tion is hypospadias, while pseudohermaphrodit-
not with Enterobacteriaceae infections. We have ism and indeterminate sex are on the last places.
also analyzed the probability of developing septic Most patients come, as expected, from urban
metastates and areas, and their age is between 5 to 14.In recent
Conclusions: The severity scores and the bio- years we observed the age of diagnosis has de-
logical markers of infection are more altered in creased and that can be a very encouraging re-
Enterobacteriaceae infections except the inflam- sult.
mation ones. Larger studies are needed in order Conclusion: The abnormalities of the male
to substantiate these preliminary results and to reproductive system represent, according to EU
determine whether this is also true for the various statistics, 12% of all congenital malformations.
genera of Enterobacteriaceae. When confronted Most of them, along with functional deficit, are
with a severe sepsis, the physician should con- accompanied by psychological problems some-
sider a Gram-negative bacteria as more likely and times major, which once again underline the im-
chose the antibiotics accordingly, pending the re- portance of recognizing the type of abnormality
sults from the bacteriological studies. and treat as early as possible.
(359) Congenital anomalies (361) Agranulocytosis after

of the male genitourinary ten years of thiamazole
system treatment for Graves
Ioan Teodor Bajeu, Marius Adrian disease
Silaghi, Laura Oana Stroica Miruna Dancau
Bucharest, Romania
Objetives: Congenital anomalies of the geni-
Background: Haematological disorders such
tourinary system represented a border between
as agranulocytosis and granulocytopenia are the
pediatric surgery and urology. In the past, new-
possible side effects that may occur during treat-
borns with various ailments were identified and
ment with antithyroid drugs for Graves-Basedow
diagnosed by pediatricians after that they asked
disease.
the pediatric surgeon to perform the interven-
Objective: We report a case of subclinical
tional gesture. If the anomalies have not been so
serious, the patients would have been diagnosed agranulocytosis after 10 years of thiamazole treat-
during adult life (e.g. cryptorchidism can be iden- ment for Gravess disease.
tified during enrollment for military service or hy- Method: The patient, a 55-years-old woman,
dronephrosis can be diagnosed during the assess- was diagnosed with Gravess disease in 2006 and
ment of hypertension). was treated continuously with thiamazole for al-
In the last 30-40 years the situation has chan- most ten years.
ged substantially worldwide. The correlation be- Results: In july 2014 the laboratory tests
tween the diagnostic and the therapeutic act, the showed leukopenia (2570/l) with neutropenia
advanced knowledge of anatomy, embryology (1120/mm^3,43.5%). In february 2015 the leu-
and physiology of the male genital system have kopenia (2900/l) with neutropenia (990/

ABSTRACTS
mm^3,34.8%) was confirmed but the thiam- Method: We have performed a retrospective
azole treatment was continued. In January 2016 study including 278 infants, aged between 2 days
the blood count showed 1210 leukocites/l with and 1 year, along with their mothers, aged 15 to
80 neutrophils/mm^3 (6.6%) and thiamazole 41 years old. The infants were admitted between
was stopped. The thyroid function test showed August 1st to October 31st, 2015 in the ber 31st,
free T4 =77.36 pmol/l and TSH <0.005 mIU/l. 2015 dy including 278 infal. Various parental fac-
The patient was admitted to our Department of tors such as age, medical history, smoking habits,
Endocrinology in february 2016, 2 weeks after pregnancy evolution, as well as term/preterm de-
the withdrawal of thiamazole without any signs of livery were evaluated. Using Epi Info 7.1.5.2 we
infection. She was under treatment with lithium determined frequencies and through applying
carbonate 500 mg per day and methylpredniso- logistic regression we calculated the correlation
lone 16 mg per day. The blood tests indicated a coefficient between the evolution of the pregnan-
slight improvement in the cell count: 3133 leu- cy and the various parental factors mentioned
kocites/l with 150 neutrophils/mm^3 (4.8%), above.
while the thyroid tests were improved significant- Results: Of the 278 mothers, 6.12% (95%CI:
ly: free T4 =31.07 pmol/l (9-19) and TSH <0.03 3.60%-9.61%) had a rich pathological history, in-
IU/ml (0.5-4.5). During hospitalisation the pa- cluding diseases such as viral hepatitis or tubercu-
tient received a higher dose of lithium carbonate losis and 74.82% (95%CI: 69.29%-79.81%) of
(750 mg per day). After 3 days the leukocite count them had a physiologically developed pregnancy.
was normal (4600/l) while the neutropenia per- The correlation between the mothered. Using Epi
sisted (400/mm^3,9.7%). An osteomedular bi- Info 7.1.5.2t 1st cxies related to the pregnancy
opsy ruled out haematological maligancies. 5 had a coefficient of -0.0093 (p=0.7498), and an
weeks later the patient was admitted again. She odds ratio of 0.9907 (%95CI: 0.9356-1.0491).
under treatment with lithium carbonate 500 mg The correlation coefficient between the presence
per day and methylprednisolone 4 mg per day. of significant pathologies in the mother the moth-
The leukocite count was normal (9240/l) with ered. Using Epi Info 7.1.5.2t 1st cxnancy was of
6310 neutrophils/mm^3 (68.3%). The thyroid -0.4125 (p=0.5254) with an odds ratio of 0.6620
function test showed free T4 =33.7 pmol/l (10.3- (95%CI: 0.1854-2.3642).
24.4) and TSH =0.018 IU/ml (0.5-4.5). Radio- Conclusion: According to the results of our
iodine therapy was recommanded and the pa- study, we have concluded that both advanced
tient received 5 mCi I-131. maternal age and a significant medical pathologi-
Conclusion: Agranulocytosis during antithy- cal background of the mother augment the risk of
roid drugs is a rare and usually severe side effect a non-physiological pregnancy evolution.
that requires drug cessation. Most cases occur in
the first months of treatment but agranulocytosis (364) The incidence of
may also occur after prolonged and well-tolerat-
ed therapy. community-acquired
pneumonia during summer
(363) The influence of Cristina Andreea Vrancianu, Petronela
maternal risk factors on Mateoiu, Florin Stoica Dumitrache,
pregnancy evolution Lavinia Alexandra Stoica
Mihaela Stefanescu1, Mihaela Roxana University of Medicine and Pharmacy Carol
Huhu2, Sebastian Ciobanu1, Ioana Davila, Bucharest, Romania
Georgescu1, Mircea Ioan Popa1, Anca Objectives: Community-acquired pneumo-
Doina Plesca1 nia (CAP) is an infectious lung disease characteris-
1
University of Medicine and Pharmacy Carol tic for the cold season, while the cases during the
Davila, Bucharest, Romania summer are less frequent. There is a big diversity
2
Childrens Clinical Hospital Dr. Victor Gomoiu, of infectious agents involved in the etiopathogen-
Bucharest, Romania esis of the disease, Streptoccocus pneumonie and
Klebsiella pneumoniae remaining the most im-
Objective: This study was aimed to investi- portant representatives. The purpose of the study
gate a link between the pregnancy evolution and is to quantify the incidence of CAP in the sum-
various maternal risk factors, such as age and per- mer, highlighting a predominant etiologic agent
sonal pathological history. for this period, the treatment that it responds to

ABSTRACTS
favorably and the most effective prophylactic ly healthy clinical and laboratory data indicate no
measures. health problem; although patients still report sub-
Methods: This observational, quantitative jective simptoms occurring during working hours.
study was conducted retrospectively by analyzing Methods: The target group (78) consisted of
the observation charts of 39 hospitalized patients employees with executive functions and high lev-
at the Institute for Lung Diseases Marius Nasta el of distress. Clinical data was recorded and car-
in the period June-August 2015. During hospital- diovascular parameters were considered such as:
ization were performed blood tests, chest X-rays blood pressure measurements, ecg recorders,
and pulmonary function tests. In the cases where echocardiography assessment. As well as a 24-
there were isolated microbial agents from sputum hour Holter-ECG was performed during patients
or bronchial aspirate, drug susceptibility test working hours.
(DST) was performed. Results: Patient history and findings show
Results: The most frequent symptoms on ad- clinically and biologically healthy patients without
mission were dyspnea (66.6%) and cough ECG changes and normal echocardiography; not-
(64.1%). Almost half (46.15%) of the patients ex- withstanding patients often accuse subjective
perienced ventilatory dysfunction, the most com- symptoms that may indicate distress asociated ill-
mon being mixed ventilatory dysfunction (30.7%). ness. Thus, performing a 24-hour Holter-ECG
In 23% of cases the causal organism was isolated monitoring during working days, detected chang-
and detected, Streptococcus pneumoniae and es such as: tachycardic heart rhythm atrial and
Klebsiella pneumoniae being the most frequent, ventricular isolated extrasistoles, with increasing
each in 8% of cases. All patients received empiri- frequency during midday working hours.
cal treatment, 44% of them following treatment Conclusion: New type of work-related hid-
with Cefoperazone in combination with Sulbac- den distress occurs in people with high level of
tam. The DST showed particular susceptibility of education. It acts probably via a mechanism in-
Streptococcus pneumoniae to the antibiotics volving excessive sympathetic nervous system ac-
from the classes of glycopeptides (Vancomycin) tivation. Better control and early detection of this
and lincosamides (Clindamycin), the results being
distress is effective way to prevent incidence of
compared with literature data.
cardiovascular reactivity that further induces or-
Conclusion: The findings are inexorably
ganic illness. 24-hour Holter-ECG monitoring is
linked to the problem of irrational use of antibiot-
an effective and accessible for every practitioner
ics that has resulted in time in the emergence of
to detect early heart rhythm modification due to
resistant strains for the classical therapy. The an-
chronic life stress. Psychotherapy, light psychotro-
nual seasonal vaccine prophylaxis and avoiding
pic medications as well as mineral supplements
exposure to ventilation systems used more often
may be indicated in this stage as wise therapy.
in the summer have a special importance in fight-
ing the infectious recurrence.
(376) Poikiloderma of
(368) Impact of chronic civatte case report
stress on the pathogenesis Anastasia Hodorogea1, Catalin Mihai
of cardiovascular reactivity Popescu1, Raluca Popescu2, Mihaela
in healthy adults Balaban2, Mihaela Antohe2
1
Lucia Maria Roatesi Colentina Clinical Hospital, Bucharest, Romania
2
Objective: Poikiloderma of Civatte is a cuta-
Objective: Chronic stress is a fact of modern neous entity caused by prolonged sun exposure
life. When stress levels surpass mental, emotional, which involves upper chest, neck and cheeks, but
and physiological limits, stress becomes distress spares the submental area. It is a common condi-
and can play a direct role in organic cardiovascu- tion with a slowly progressive and irreversible
lar pathology. Unfortunately healthy adults often course of action. Other factors associated with
deny and hide well their distress symptoms, going this condition, such as genetics, low estrogen,
from one stressful situation to the next without phototoxic or photoallergic reactions to cosmet-
taking time to relax. ics chemicals have been proposed. Chronic sun
Early assesement of hidden cardiovascular re- exposure may be associated with the appearance
activity must be taking in discution when aparant-

ABSTRACTS
of Favre-Racouchot syndrome, actinic keratoses, A large number of noncardiac comorbidities

basal cell carcinoma and squamous cell carcino- were evaluated.
ma. IPL (Intense Pulsed Light), PDL (pulsed dye The most important comorbidities in heart
laser) or KTP laser have proven their efficacy in failure patients was anemia, diabetes mellitus,
treating poikiloderma of Civatte. chronic obstructive pulmonary and renal insuffi-
Methods: We report the case of a 56-year-old ciency.
woman who presented with an erythematous There were 35 patients with diabetes in the
eruption which appeared a few years before. study group. The risk intensity increase by 85% in
Clinical examination revealed pigmentation, tel- patients with heart failure and diabetes (p 0.025).
angiectasia and epidermal atrophy on the lateral The risk intensity increase by 20% in patients
side of the neck and upper chest without involv- with heart failure and stroke history (13 men and
ing the submental area. The patient states work- 9 women).
ing in a sun exposed environment for more than There were 8 patients in the study group (4
25 years and she did not follow any photo protec- men and 4 women) that was associated to chron-
tion rules. ic obstructive pulmonary cardiac pathology. Pa-
Results: The morphology and topography of tients with heart failure and COPD have a re-
the lesions were suggestive for poikiloderma of duced survival, no patients survived more than 36
Civatte. Since the eruption was typical no biopsy months.
was performed. The patient was assured by the There was a direct proportionality between
benign character of the lesions and she refused anemia severity and mortality, an increase in he-
the proposed treatment using laser. She was pre- moglobin is associated with an improvement in
scribed a sunscreen cream and limitation of sun the survival.
exposure. Conclusion: Comorbidities are frequent and
Conclusions: We report a typical case of poi- have a great impact on HF prognosis. Heart fail-
kiloderma of Civatte in a 56-year-old Caucasian ure comorbidities management is of special inter-
woman, with a history of prolonged sun expo- est and often challenging.
sure. It is important to recognize poikiloderma of
Civatte because of its benignity and to avoid un- (378) Tinea incognito
necessary biopsies and invasive treatments.
Anastasia Hodorogea1, Catalin Mihai
(377) Heart failure Popescu1,2, Raluca Popescu2, Mihaela
comorbidities and prognosis Antohe2, Mihaela Balaban2
1
Colentina Clinical Hospital, Bucharest, Romania
Lucian Axente1, Catalina Andrei1, 2
Valentin Chioncel2, Gabriel Bazacliu2, Davila, Bucharest, Romania
Crina Sinescu1,2
1
Objective: Tinea incognito is a dermatophytic
Department of Cardiology, Emergency Hospital
infection which is clinically modified by self-med-
Bagdasar-Arseni, Bucharest, Romania
2
ication and application of topical or systemic im-
munosuppressants. The most common types of
treatment that induce this entity are corticoste-
roids and immunomodulators such as pimecroli-
Objective: Heart failure (HF) affects nearly
mus and tacrolimus. These drugs action is to sup-
2% of the adult population and is one of the lead-
press the normal cutaneous immune response to
ing cause of hospitalization in elderly population.
dermatophytes and therefore increasing the de-
Management of HF many comorbidities is ex-
velopment of fungal superficial infections. This
tremely important for improving the prognosis of
acute heart failure. type of lesion can be misdiagnosed and thus the
The objective of this study is to assess the im- treatment delayed because it resembles atopic
pact of common comorbidities in acute heart fail- dermatitis, rosacea, neurodermatitis, seborrheic
ure prognosis. dermatitis or contact dermatitis.
Methods and Results: Methods: We report two cases of tinea incog-
Our lot included 96 hospitalized patients with nito who referred to our clinic. The first case is a
acute heart failure diagnosis. There was an equal 52-year-old male patient who presented an ery-
number of women and men with an average age thematous eruption on the right thigh, knee and
of 72 years. upper calf. Clinically the plaque was diffuse and
had white scales on the surface, telangectasias,

ABSTRACTS
papules, pustules and some crusts. The second Methods: We report the case of a 62-year-old
case is a 5-year-old male child who presented an man, Fitzpatrick skin type II, who presented for a
erythematous plaque on the left cheek and chin. painful nodule over the right cheek, evolving for
The clinical examination revealed an imprecisely 2 years, with inflammation for 2 weeks before the
defined lesion with papules, telangiectasias and presentation. Clinical examination revealed a
fine scales on the surface. round-shaped, 4 cm in diameter, erythematous
Results: The first patient stated having ap- and yellowish, painful cyst located in the right
plied topical steroids for two weeks and at the malar area. Moreover, signs of solar elastosis were
end of the treatment the worsening of the previ- observed on the entire face, characterized by yel-
ous lesion. The second patients mother admitted low plaques, deep wrinkles and furrows, on a
self-medicating the child with topical corticoste- background of yellow, atrophic skin, with open
roid for one week after which the lesion exacer- and closed comedones. He admitted having an
bated. The clinical history and the mycological outdoor occupation and a history of chronic sun
exam revealed tinea incognito in both cases. Both exposure in the last 40 years and he had never
patients were told to stop the corticosteroid ther- used sunscreen cream.
apy and were prescribed oral antifungals (flucon- Results: The facial eruption was suggestive of
azole) and topical miconazole for 4 weeks and Favre-Racouchot syndrome. The patient was pre-
were told to continue for another 2 weeks after scribed antibiotic treatment for 7 days, with the
the disappearance of the symptoms. At the end of decrease in size and inflammation of the cyst.
the treatment the patients came to a follow-up Consequently, under local anesthesia with lido-
consult where complete resolution was observed. caine 1%, incision and drainage of the malar cyst
Conclusions: Tinea incognito must be thought were performed, followed by evacuation of se-
of when we face an unrecognizable or altered bum and horny material and dressings. The evo-
skin condition on which it was previously applied lution was favorable, with gradual healing in the
a topical steroid or immunomodulatory such as next 6 days. The patient refused treatment for
tacrolimus or pimecrolimus. It is of utmost impor- Favre-Racouchot syndrome.
tance to recognize this entity and act accordingly Conclusions: Favre-Racouchot syndrome re-
since it can be easily misdiagnosed and further presents a cutaneous disorder secondary to chro-
inappropriately treated. nic sun exposure. Patients should be advised to
limit sun exposure and to follow sun-protection
(380) Favre-Racouchot measures, including sunscreen creams, in order
to avoid photoaging.
syndrome: case report
Mihaela Balaban1, Catalin Mihai (381) Dermatitis artefacta:
Popescu1,2, Raluca Popescu2, a case report
Mihaela Antohe2, Anastasia Hodorogea2
Mihaela Balaban1, Catalin Mihai
1
Colentina Clinical Hospital, Bucharest, Romania Popescu1,2, Raluca Popescu2, Mihaela
2
Antohe2, Anastasia Hodorogea2
1
2
Objectives: Favre-Racouchot syndrome, also University of Medicine and Pharmacy Carol
known as nodular cutaneous elastosis with cysts Davila, Bucharest, Romania
and comedones, refers to skin changes mostly af-
fecting the periorbital area, due to chronic expo- Objectives: Dermatitis artefacta, a psychocu-
sure to ultraviolet light and smoking. Ultraviolet taneous disorder affecting mostly women, is char-
radiation determines elastic fibers degeneration acterized by self-induced lesions in accessible re-
and hyperplasia of the sebaceous glands, dilation gions of the body, created by the patient in order
of the pilosebaceous openings, which fill with se- to satisfy a psychological need. An onset during
bum and horny material, clinically noted as com- adolescence or in early adulthood had been ob-
edones, cysts and nodules. Long-term exposure served. Usually, the patients deny having any role
to sun light may also determine the appearance in the appearance of the injuries. Clinically, der-
of solar lentigines, poikiloderma of Civatte, milli- matitis artefacta can resemble other dermatoses,
um cysts, solar purpura, actinic keratoses, basal leading to misdiagnosis or on the contrary, the
cell carcinoma and squamous cell carcinoma. As aspect may not correspond to any dermatologic
therapy options, topic retinoic acid, cryotherapy condition. The lesions may be in various stages of
and surgical techniques had been proposed. healing, single or multiple and their aspect may

ABSTRACTS
range from vesicles to erosions, ulcerations and crolysis. Antibacterial sulfonamides, antibiotics,
scarring, mostly with angulated borders, with bi- nonsteroidal antiinflammatory drugs, analgesics,
zarre, geometric shape. Usually, the patient has and hypnotics are the most frequent causes of
an underlying psychiatric disorder. Blood tests FDE.
and histopathologic examination are non-specif- Methods: We report the case of a 54-year-old
ic. A topical treatment and psychiatric referral is woman who presented for two oval, erythemato-
the appropriate management for this disorder. violaceous plaques located on the breasts, sharply
Methods: We present the case of 42-year-old demarcated, with 3/2 cm and 8/6 cm in diameter.
woman, who presented for painful erosions on The lesions appeared 5 days after she took eryth-
the neck, which appeared 1 year before. Clinical romycin for an infection of the upper respiratory
examination revealed 2 round-shaped, well de- tract. They were accompanied by burning sensa-
marcated erosions over the lateral aspect of the tion and mild pruritus, without general symp-
left cervical area, 2 cm in diameter, with a whitish toms.
scale at the periphery, associated with hyperpig- Results: The history and the clinical findings
mentation and multiple white, round and linear of the patient were suggestive for a fixed drug
scars, arranged in a parallel pattern on the left eruption presumably induced by erythromycin.
part of the neck, extending into the left cheek. We recommended to avoid this drug and the
The patient was not able to explain the evolution chemically related drugs.The treatment was only
of the lesions and she denied self-harm. symptomatic, focused on the relief of the pruri-
Results: Based on the clinical aspect of the tus.
lesions, a clinical diagnosis of dermatitis artefacta Conclusion: The diagnosis of fixed drug erup-
was made. We decided to perform a biopsy from tion (FDE) in its typical presentation is usually
the erosion, but the patient disagreed with the straightforward, based upon lesion morphology
idea. She was prescribed topical antibiotic and and history. A careful medication history is re-
occlusive dressings, in order to limit self-injury quired to elicit the fact that a drug has been taken
and she was referred to the psychiatric depart- and is temporally related to the onset of the erup-
ment. She did not return for further follow-up. tion. Systemic or topical provocation tests may be
Conclusions: Dermatitis artefacta is a chal- useful in identifying the culprit drug when history
lenge diagnosis, with a poor prognosis for cure, is unclear or multiple medications are suspected.
which requires multidisciplinary evaluation and
dermatologists should consider an empathetic
and nonjudgmental aproach, for better results. (389) Detecting Etanercept
serum level and
(382) A case of a fixed-drug immunogenic profile
eruption presumably due to useful tool in monitoring
erythromycin spondyloarthritis patients?
Mihaela Antohe1, Catalin Mihai Claudia Deaconu1, D. Opris1,2,
Popescu1,2, Raluca Popescu2, Mihaela D. Mazilu1,2, A. Borangiu1,2, Laura
Balaban2, Anastasia Hodorogea2 Groseanu1,2, I. Saulescu1,2, M. Negru1,2,
1
Colentina Clinical Hospital, Bucharest, Romania C. Constantinescu1,2, Violeta Bojinca1,2,
2
University of Medicine and Pharmacy Carol V. Vlad1, A. Balanescu1,2,
Davila, Bucharest, Romania D. Predeteanu1,2, Ruxandra Ionescu1,2
1
Objectives: Fixed drug eruption (FDE) is a dis- Department of Rheumatology and Internal
tinctive type of cutaneous drug reaction that typi- Medicine, Sfanta Maria Clinical Hospital,
cally recurs in the same locations upon reexpo- Bucharest, Romania
2
sure to the offending drug. Acute FDE usually University of Medicine and Pharmacy Carol
presents with a single or a small number of dusky Davila, Bucharest, Romania
red or violaceous plaques that resolve leaving
postinflammatory hyperpigmentation. The diag- Background: Anti-TNF (tumor necrosis factor)
nostic hallmark is its recurrence at previously af- agents have highly proved their efficacy in spon-
fected sites. Rare severe atypical variants of FDE, dyloarthritis (SpA) patients, having a good rate of
including multiple, nonpigmenting, and general- response of approximately 70%. However, pa-
ized bullous variants, share clinical features with tients who initially benefited from therapy with a
Stevens-Johnson syndrome/toxic epidermal ne- TNF inhibitor lose response. This might be due to

ABSTRACTS
undetectable drug level resulting from anti-drug 40% of patients needed tuberculosis prophylaxis,
antibody production. due to positive Quantiferon test. Mean treatment
Objectives: The aim of this study was to eval- persistence was 51 months 23.3. Out of the 32
uate the drug level and immunogenic profile of patients, two had undetectable drug serum level.
patients with SpA on etanercept and its relation Without reaching statistical significance, mean
to disease activity as well as the frequency of values of disease scores and inflammatory mark-
NSAID consumption. ers were higher in the ETA-negative group (BAS-
Methods: This study was prospective, obser- DAI 1.85, ASDAS-CRP 2.42, CRP 24.7 mg/l, ESR
vational and cross-sectional. Over a period of 37 mm/h). Interestingly, drug serum level corre-
eleven months, 46 patients with established SpA, lated to ASDAS-CRP (r= -0.432, P=0.01) but not
both axial and peripheral forms, were enrolled. to ASDAS-ESR or BASDAI. In our study group,
No patient had synthetic DMARD and NSAID drug serum level did not correlate to NSAID in-
self-administration was on demand. The exclu- gestion among patients. No anti-ETA antibodies
sion criteria consisted of discontinuation or delay were found. 19% of patients on ETA had had an-
in treatment administration in the last three other anti-TNF agent, namely 66% were previ-
months or concomitant infection. Demographic, ously on adalimumab and 34% on infliximab,
clinical and laboratory parameters were collect- switching after a mean period of 4 years.
ed. Serum drug levels and anti-drug antibodies Conclusions: Etanercept proves to have a low
were measured using the ELISA method. The sta- immunogenicity among other common anti-
tistical analysis used SPSS 20.0. TNFs. This can help when switching a patient
Results: Thirty-two patients were eligible, who has priorly developed anti-drug antibodies.
69% were males and 87% presented HLA B27 Correlating drug serum level to disease activity
antigen positivity. The mean age was 44.3 y.o scores might help us find a personalized adjusted
11, with mean disease duration of 101 months. therapeutic scheme.

S URGICAL S PECIALITIES
(8) Quality of life Conclusions: Quality of life overall, 77.78%

declared a vastly improvement, 11% a good qual-
assessment after ity of life and only 3.7% said quality of life is
longitudinal gastrectomy worse than before the surgery. Improving quality
of life directly correlates with the number of lost
for obesity the experience kilograms and %EBWL and so with the postoper-
of a single team ative BMI. Also there is a direct relationship be-
tween QoL and improved sexual life and increas-
Radu Mihail Mirica1, Alexandra Mirica3, ing the frequency of making sport.
Mihai Ionescu1, Octav Ginghina1,
Razvan Iosifescu1, Adrian Rosca2, (14) The impact of narrow
Rubin Munteanu4, Clarisa Birlog1,
Andrada Spanu1, Nicolae Iordache1,
band imaging cystoscopy in
Leon Zagrean2 non-muscle invasive
1
Emergency Hospital St. John, Bucharest, bladder tumors diagnostic
Romania accuracy
2
Department of Physiology and Neuroscience,
University of Medicine and Pharmacy Carol Teodora-Cristiana Otelea1,
Davila, Bucharest, Romania Bogdan Geavlete2
3
National Institute of Endocrinology C.I. Parhon, 1
Bucharest, Romania Davila, Bucharest, Romania
4
Euroclinic Hospital Regina Maria, Bucharest, 2
Department of Urology, Emergency Hospital
Romania St. John, Bucharest, Romania
Objectives: Obesity is an extremely current Objectives: A retrospective clinical analysis
pathology with many clinical, molecular and psy- was performed while aiming to establish the im-
chological implications. In the past 10 years the pact of narrow band imaging (NBI) cystoscopy in
number of obese people has doubled and the age cases of non-muscle invasive bladder cancer
at which they occurring is becoming smaller. (NMIBC) within a comparison to the standard
Method: We conducted a qualitative quanti- white light cystoscopy (WLC).
tative and exploratory study on 34 obese patients, Method: 139 patients were consecutively di-
from the Emergency Hospital Sf. Ioan, Bucharest, agnosed with NMIBC based on conventional
that undergone surgery for obesity. Inclusion cri- WLC followed by NBI cystoscopy as complemen-
teria were the embodiment of surgery for obesity: tary investigation. The bladder cancer suspicion
BMI; 40 kg/m2 or BMI; 35 kg/m2 and associated was established based on the presence of hema-
comorbidities. We used a modified BAROS and turia, positive urinary cytology and/or ultrasound
SF36TM questionnaire. aspect suggestive for bladder tumors. The classi-
Results: The mean postoperated BMI was cal transurethral resection of bladder tumors
25.7670 3.74759 (StDev). The average num- (TURBT) was performed for all white light visible
ber of lost kilos was: 38.74 12.526 (StDev), lesions while NBI-guided TURBT was applied ex-
and the average %EBWL 85.9952 22.69028 clusively for tumors solely discovered in this vi-
(StDev). Since 6-12 months after surgery patients sion mode.
lost an average of 36.88- 38.56 kilograms and af- Results: Among the carcinoma in situ (CIS)
ter 18 months postoperatively they reach a EBWL patients, NBI cystoscopy emphasized a superior
of 92.39% - 96.99% and a normal weight BMI of diagnostic accuracy concerning the cases (92.3%
23.96 kg/m2. All patients after surgery significantly versus 69.2%) as well as lesions (93.75% versus
reduced the amount of food eaten. More than 2 71.9%) detection rates. NBI-TURBT provided a
years after the surgery patients increase their food higher proportion of additional tumors cases
intake by about 30%, but maintain their weight (53.8% versus 15.4%) when compared to classical
loss and a normal weight BMI resection but was marked by an increased fre-

ABSTRACTS
quency of false-positive results (18.9% versus interleukin 6. In haemodynamically stable pa-

11.5%). Moreover, a significantly higher patients tients (8 cases) early total care (ETC) was per-
related detection rate was underlined for the NBI formed and in the other 16 borderline and stable
vision mode with regard to both pTa (95.3% ver- patients external fixation (DCS) was chosen, fol-
sus 87.1%) and pT1 (97.6% versus 92.7%) stages. lowed by internal fixation only after the systemic
Concerning the number of tumors, the respective inflammatory response subsided. General com-
proportions remained substantially increased plications (mortality, incidence of ARDS and
subsequent to the use of narrow band imaging MSOF) and length of stay were evaluated.
(96.9% versus 90.8% detection rate for pTa and Results: The analysis of the data revealed that
97.4% versus 94.9% for pT1 stage lesions). Con- multidisciplinary team application of DCS lead to
sequently, a distinctively larger category of cases a lower incidence of complications (although
were identified as presenting supplementary le- without statistical significance) Acute inflamma-
sions during the NBI examination (17.6% versus tion tests were correlated with mortality and
5.9% in the pTa group and 9.7% versus 4.8% complication rates. Of these tests, IL 1 and IL 6
among pT1 patients). The frequency of negative had the best capacity to predict complications. In
biopsies remained elevated for the NBI-guided patients where definitive stabilization was per-
TURBT by comparison to the classical resection formed only after the remission of the inflamma-
(14.3% versus 9.6% rate of false positive results tory syndrome, the rate of complications was
for the pTa series and 8.4% versus 5.1% for pT1 much lower.
cases). Conclusions: For the multidisciplinary spe-
Conclusions: NBI cystoscopy and resection cialty team, the inflammatory tests and especially
substantially ameliorated the NMIBC-related di- IL 1 and IL6 represent useful tools for more effi-
agnostic accuracy within a parallel to the standard ciently managing polytrauma patients.
approach at the cost of a relatively reduced spec-
ificity, regardless of tumor stage. Subsequently, (16) Modern interactive
NBI-TURBT was able to find more bladder cancer
patients as well as lesions, thus improving the pre- approach in training
cision of the endoscopic treatment. orthopedics using
e-learning
(15) Therapeutical value of
Olivera Lupescu1, Tania Elena
biochemical correlations in
Avramescu3, Cristina Patru2,
polytrauma patients with Gheorghe Ion Popescu2, Mihail Nagea2
pelvic fractures 1
Doriana Lupescu, Alexandru Dimitriu, Davila, Bucharest, Romania
2
Alexandra Totan, Maria Greabu, Clinical Emergency Hospital, Bucharest,
Romania
Olivera Lupescu 3
Craiova University, Romania
Davila, Bucharest, Romania Objectives: Modern medicine requires com-
plex training of the physicians, in order to face
Objectives: The purpose is to evaluate the the rapid changes of pathology and therapeutic
potential clinical correlations between inflamma- means. The objective of this paper is to present a
tory markers and the steps of managing polytrau- multidisciplinary approach in training orthopedic
ma patients. This idea is valuable because it forms surgeons, using e-learning as an educational tool.
the basis of the concept of damage control sur- Method: This paper presents the experience
gery (DCS), which the Anaesthesia and Intensive expanding the results of the Leonardo da Vinci
Care doctor helps implement. project (transfer of innovation), named A Web-
Method: The authors retrospectively evaluate based E-Training Platform for Extended Human
24 patients admitted to the Clinical Emergency Motion Investigation in Orthopedics, addressed
Hospital of Bucharest during 01.01.2013- to orthopedic trainees, with interdisciplinary ap-
01.06.2015 with multiple trauma and pelvic frac- proaches. The main result of the project is a Vir-
tures. The following acute inflammation tests tual Training & Communication Center ORTHO-
were monitored: white blood cell count, ESR, fi- eMAN for innovative education - on-line edu-
brinogen, C reactive protein, interleukin 1 and cation and training material accessed using a

ABSTRACTS
standard web browser, which provides an inte- that all these factors are influence by the pathol-
grated on-line learning environment. ogy of polytrauma, There is a direct correlation
Results: The teaching materials were created between ECR and hemoglobin level and the inci-
by a multi-disciplinary team, and the unique fea- dence of septic complications, as well as between
ture of this e-learning platform is that it contains CK and the outcome of the patients. Renal func-
not only courses, but also interactive training mation was also influenced by the CK and ECR lev-
terial with real clinical case studies. The trainees els.
analyze the given clinical or imagistic informa- Conclusion: When crushing is responsible for
tion, regarding the patient, and establish, within the trauma, due to the systemic effects of rhabdo-
an interactive process, the diagnosis and treat- myolysis, several biochemical markers can be
ment. As in real situations, each step of the algo- used as predictive elements for the outcome of
rithm must be followed, otherwise the outcome the patients. Whether they can be used in guiding
of the patient is negative. the treatment or not, itg is still necessary to be
Conclusion: Complex changes in medicine studied.
concerning diagnosis and treatment generated
major educational challenges, since medical
training has to reflect the multi-disciplinary ap- (18) Multidisciplinary
proach of modern medicine The project present- approach in complex
ed in this paper uses a pluridisciplinary approach
and significantly improves the image-based diag-
injuries of the limbs
nostic and therapeutical skills of the orthopedic Olivera Lupescu1, Mihail Nagea2,
trainees, which were not at all targeted by the
Alexandru Dimitriu1, Nicolae Ciurea2,
classical courses and dissections.
Doriana Lupescu1,3, Alina Grosu2
1
(17) The significance of University of Medicine and Pharmacy Carol
inflammatory markers for 2
Clinical Emergency Hospital, Bucharest,
the outcome of the patients Romania
3
Buftea Hospital, Romania
with mangled extremities
Alexandru Dimitriu1, Doriana Lupescu1, Objectives: Complex trauma of the limbs are
Nicolae Ciurea2, Mihail Nagea2, Olivera produced by high energy, thus being character-
ized by limb- and life-threatening injuries, with
Lupescu1 considerable risk for complications, both systemic
1
University of Medicine and Pharmacy Carol (such as Acute Renal Failure, MSOF, or even
Davila, Bucharest, Romania death) and local (infection, or even amputation).
2
Clinical Emergency Hospital, Bucharest, The objective of this study is to demonstrate the
Romania efficacy of an interdisciplinary approach, using
severity scores (such as MESS) to evaluate the in-
Objectives: Mangled extremities are severe juries.
injuries threatening not only the damaged ex- Method: Authors retrospectively analyze 36
tremity, but also the patients life, so their treat- complex crushing injuries operated in a complex
ment must be carefully monitored as to assure team orthopedist-plastic surgeon- anesthetist-
maximum of efficacy. vascular surgeon between 01.01.2010-01.01.
Methods: The authors retrospectively evalu- 2015 with MESS values 4-6, using the following
ate 21 patients with mangled extremity operated criteria: age, the injured tissues, the mean time
between 01.01.2013-01.01. 2015 from the point from trauma to surgical treatment, systemic re-
of view of demography, traumatic mechanism sponse to aggression, contamination at admission
and injury severity. Local scoring systems were (diagnosed using cultures before lavage), mean
used to describe the anatomy of the injured zone, time of hospitalization, local and systemic com-
while general parameters (especially the inflam- plications, outcome at 12 months. The protocol
matory ones) are evaluated as potential bio- was the same for all the patients- immediately af-
chemical markers. ter admission the patients were operated- de-
Results: From the tests, hemoglobine level, bridement, lavage, stabilization of the fractures
CRP, ESR, fibrinogen, as well as IL ( 1 or/an 6) are using external fixators. Internal fixation was sec-
to be thoroughly evaluated in polytrauma pa- ondarily performed after soft tissue healing (mean
tients. This study, although limited, demonstrate time 4 months after trauma)

ABSTRACTS
Results: Mean age was 36 yrs. (14-48 yrs.); er confirmed by cultures (St. aureus). The exter-
the injuries were crushing open fractures (4 cases nal fixator was repositioned, then repeated de-
III A, 16 cases III B, 6 cases IIIC), complicated bridements were necessary in order to assure the
with: compartment syndrome (16 cases), Acute vitality of the fracture site. General antibiotic
peripheral Ischemia (6 cases) and polytrauma (18 treatment was started with broad spectrum anti-
cases). Mean time from trauma to surgical treat- biotics and then performed according to the re-
ment was 4 hrs (2-48 hrs.); mean hospitalization sults from the culture. After sustained local and
was 48 days; complications were: sepsis (10 cas- general treatment, the outcome was positive, se-
es), DVT (4 cases), Pulmonary Embolism (4 cases), cretion diminished and then disappeared skin
Acute Renal Failure (ARF) (3 cases), pseudarthro- graft was used in order to cover the defect. Se-
sis (8 cases). The complications were associated quential method was considered to be suitable
to increased MESS, prolonged time from trauma for the patient, external fixation being followed
to treatment and haemodinamical instability and by intramedullary nail after all the signs of inflam-
anemia at admission. Amputation was performed mation disappeared.
in a patient who arrived at the hospital 4 days af- Infected fractures are frequent after complex
ter trauma, with ARF, the patient recovered. high energy trauma; they require a prolonged
Conclusions: Complex traumas of the limbs and complex treatment, both local (optimal stabi-
are increasingly frequent injuries affecting young lization of the fracture and repeated and thor-
people, threatening not only the vitality of the af- ough debridemenents in the operating theatre)
fected limb, but also that of the patient, due to and general (antibiotics and supportive treatment)
their considerable systemic impact. Urgent com- and a well-trained interdisciplinary team
plete treatment in a pluridisciplinary team fol-
lowed by sustained multidisciplinary monitoring (20) Infections after open
represent the key of success in these cases.
fractures time from
(19) Infected closed femoral trauma to surgical
fracture after high energy debridement is the key
trauma case presentation factor
Alexandru Dimitriu1, Mihail Nagea2, Olivera Lupescu1, Mihail Nagea2,
Nicolae Ciurea2, Mihai Coltan2, Alexandru Dimitriu1, Nicolae Ciurea2,
Olivera Lupescu1 Mihai Coltan2, Alina Grosu2
1
1
University of Medicine and Pharmacy Carol University of Medicine and Pharmacy Carol
2
2
Clinical Emergency Hospital, Bucharest, Clinical Emergency Hospital, Bucharest,
Romania Romania
Crushing trauma of the extremities, involving Objective: Septic risk after Open Fractures
both bones and soft tissues, are frequently com- (OF) is unanimously recognised but the factors
plicated with infection, which threatens not only influencing its onset have not been yet clearly
the functional outcome, but also the vitality of the quantified. The authors intend to check in this
injured limb, and of the patient. We present a paper the hypothesis that time form trauma to
clinical case reflecting the difficulties in treating initial complete surgical debridement influences
infected fractures in mangled extremity. The pa- the onset of infection after OF.
tient, patient, male, 45 years old, was admitted in Method: A retrospective study was performed
the Orthopedics and Trauma Clinic of Clinical in a Level 1 Trauma Center regarding OF operat-
Emergency Hospital Bucharest 4 days after a traf- ed between 01.06.2008-01.06.2013, with a min-
fic accident, with a femoral fracture after a crush- imum of 18 months follow-up after trauma. From
ing injury, with a tensioned suture on the thigh, 588 patients with open injuries, only 362 com-
blisters and a partially stable external fixator. Ini- pleted the follow-up, thus being included in this
tial thorough debridement was performed, lavage study. Demographic and pathogenic criteria
and opening the tensioned suture, with a consid- (Gustillo classification) were used, together with
erable residual skin defect; muscular debris, oe- treatment assessment by: type of bone stabiliza-
dema of the soft tissue and modified aspect of the tion, time from trauma to the first antibiotic dose,
haematoma raised the suspicion of infection, lat- time from trauma to surgical complete debride-

ABSTRACTS
ment. The outcome was described by the inci- surgery to radiotherapy in treating patients with
dence of superficial and deep infections within advanced cervical cancer in Romania.
the first 18 months after trauma. Methods: Between 2010-2015, in the De-
Results: Following Gustillo Classification, partment of Surgical Oncology from Oncologic
there were 172 type I, 101 type II and 90 type III Institute in Bucharest, 150 women diagnosed
open fractures. The mean time from trauma to with stage IB2-IVA cervical carcinoma were treat-
first antibiotic dose was 2.8 hrs (30 min-6 hours). ed by the same multidisciplinary team, according
The type of bone stabilization was external (58%), to the same protocol. Patients were staged as fol-
initial contamination was present in 60 % of the lows: IB2-17, IIA2-4, IIB-111, IIIB-15, IVA-3.
fractures. Mean time from trauma to initial de- Treatment consisted of external beam radia-
bridement was 3 hrs (42 min-48 hrs). The inci- tion therapy (EBRT) to a dose of 50.4Gy given in
dence of infection was 6.9 %, significantly higher 5 weeks, with concurrent weekly cisplatin at
(p<0.05) for type III OF, but, regardless of the 40mg/m2. EBRT was supplemented with 2 endo-
type of the fracture, stabilization type did not sig- cavitary applications each delivering 7.5Gy at
nificantly influence the incidence of infections. point A, followed after 6-8 weeks by type II radi-
On the contrary, time between trauma and anti- cal hysterectomy for patients reconverted to op-
biotic treatment significantly increased the inci- erability.
dence of sepsis from 4.8% (antibiotics before 3 Results: All patients were reassessed after a
hrs) to 7.8 % (antibiotics after 3 hrs), while time point A total radiation dose of 65Gy and were
from trauma to debridement increased the risk considered operable. Pathological analysis of rad-
from 3.8% (debridement before 6 hrs) to 7.6% for ical hysterectomy specimens showed that 68 pa-
debridement after 6 hrs. tients (45.3%) had residual tumor in the cervix,
Conclusions: The current study suggests that, and 5 of them in iliac lymph nodes too. The per-
more than the time from trauma to antibiotics, centage of non-sterile pieces increased parallel
time from trauma to proper surgical debridement with tumor clinical stage: 23.5% in stage IB2,
is essential for the incidence of infection. Despite 45.9% in IIB and 73.3% in IIIB. In our study
its limitations, this study suggests that surgical
group, administration of 65Gy in point A, a dose
treatment is unfairly underestimated, being at
close to that considered therapeutic by most
least as important as the antibiotics, due to the
guidelines, failed to sterilize primary tumor in
characteristics of open fractures.
nearly half cases.
Conclusion: Given the high percentage of
(37) Is there any role for cases with persistent neoplastic cells in irradiated
surgery in advanced stage tissues and the undersized radiation network in
our country, we believe that association of surgery
cervical carcinoma? to radiation therapy according to the protocol de-
Silviu Cristian Voinea1,2, scribed above is warranted in advanced cervical
cancer.
Raluca Nicolaescu2, Mircea Savu2,
Anca Ciobanu2, Angela Sandru2
(49) Wire-guided surgical
1
resection of lobular
2
Oncologic Institute, Bucharest, Romania carcinoma in situ of the
breast: case report
Background: Cervical cancer incidence and
mortality rates in Romania are the highest in Eu- Sandra Iordache, Ionut Negoi
rope. Increased mortality rate is partly explained
Clinical Emergency Hospital, Bucharest, Romania
by diagnosis of cancer in advanced stages due to
lack of a nationwide screening program. The
Background: In situ lobular carcinoma and
growing number of patients requiring radiothera-
intraductal epithelial atypical hyperplasia are
py and the low capacity of irradiations centers in
our country influence the choosing of treatment breast lesions with an increased risk of breast can-
plan. Thus in Romania the protocol applied in ad- cer. These types of lesions are easily identified
vanced stages of cervical cancer differs to some during screening paraclinical examinations like
extent from that recommended in international ultrasound, mammography and magnetic reso-
guidelines nance imaging.
Objective: This retrospective study aims to Objective: To illustrate a case of early nonpal-
analyze the reasons underlying the association of pable breast cancer detected on screening mam-

ABSTRACTS
mography and managed by guide-wire conserva- elastography at head and neck level. Afterwards
tive surgical resection. the ENT specialist compares elastography param-
Methods: Case report and review of the Eng- eters not only concerning the salivary pathology
lish language literature. but also from the rest of the head and neck region
Results: A 46 year-old female patient with fa- in order to establish a general ratio of stiffness for
milial history of breast cancer, was referred for the case analyzed. Moreover the initial diagnosis
surgical resection of a nonpalpable left breast le- of benign/malignant is compared with final surgi-
sion, detected on screening mammography. The cal pathology results.
clinical exam of the breasts and axilary regions Results: We applied our sonoelastography
was normal. After mammography wire-guided lo- protocol to 28 consecutive cases with salivary
calization of the microcalcifications the surgical glands pathology. Our case series contained: 4
resection of the involved area was performed, us- Warthin tumors, 6 pleomorphic adenomas, 2 li-
ing a periareolar incision. The pathology report of poma, 2 lymphadenopathies, 4 cases with sialoli-
the four/four cm tissue fragment revealed a lobu- thiasis, 6 adenocarcinomas, 2 malignant lympho-
lar carcinoma in situ and intraductal epithelial mas. In 6 cases sonoelastography changed sig-
atypical hyperplasia, completely resected, with- nificantly the diagnosis and we discus if it subseq-
out involvement of the transected margins of the uently changed the surgical management and
specimen. prevented possible malpractice. Clearly it en-
Conclusions: Wire-guided surgical resection abled watchful waiting with serial dynamic imag-
of an adequate tissue volume to allow negative ing of the chronic benign salivary glands patholo-
margins, while maintaining the local cosmesis gy and a patient informed decision for further
should be the aim of surgical resection. An expe- surgery.
rienced pathologist is needed to assess the early Conclusions: There is still a need of further
breast lesions and their complete resection. data for an evidence- based decision and even
Key words: surgery, wire-guided, lobular car- cheaper equipment in order to introduce elastog-
raphy as a standard in daily practice for the cost
cinoma in situ, intraductal epithelial atypical hy-
efficient management of salivary glands patholo-
perplasia.
gy. This work was supported by UMF Carol Da-
vila a project number 33895/11.11.2014.
(61) Is elastography the new
safety belt in salivary (63) Nosocomial infections
glands surgery? in obstetrics a permanent
Mihai Dumitru1, Romica Cergan1, challenge
Florin Filipoiu1, Ion Anghel2, Cristina Vasiliu1, Ana Badanoiu2,
Codrut Sarafoleanu3 Mara Carsote1,3, Simona Elena Albu1,2
1
Department of Anatomy, University of Medicine 1
and Pharmacy Carol Davila, Bucharest Davila, Bucharest, Romania
2
Department of ENT, Coltea Clinical Hospital, 2
University Emergency Hospital, Bucharest,
Bucharest, Romania Romania
3
Department of ENT, Clinical Hospital Sf. Maria, 3
National Institute of Endocrinology C.I. Parhon,
Bucharest, Romania Bucharest, Romania
Objectives: Even before standardization so- Objective: Nosocomial infections (NI) are a
noelastography recorded an upgrade in tech- challenge for modern medicine: they are a major
niques from shear wave elastography to strain ra- cause of morbidity and mortality in hospitals and
tio elastography. Based on our systematic review are associated with high costs. It is only recently
concerning its use we introduced elastography in that they have been correctly defined and report-
our routine daily practice in the diagnosis and ed and their true prevalence in our hospitals is
management of salivary glands pathology. Fur- not known. The aim of our study is to observe the
thermore the cases were analyzed by the ENT magnitude and characteristics of NI in a depart-
specialist using a portable ultrasound device. ment of obstetrics.
Method: We present a seven step protocol of Methods: It is a retrospective observational
examining the patient with salivary glands pathol- study evaluating the NI diagnosed in the Clinic
ogy not only focusing on the salivary region but Department of Obstetrics of S.U.U.B between
recording data both in standard ultrasound and 01.07.2014 01.07.2015.

ABSTRACTS
Results: In the above interval 3524 deliveries women, with few cases diagnosed before the age
were registered and 74 nosocomial infections of 40 years, diagnosed at a distant stage, under-
were identified. 12 of these occurred after vaginal scoring the difficulty of diagnosing this malignan-
births, 42 after caesarean section and 20 during cy. It has been recognized for almost 5 decades
pregnancy. Age of patients ranged from 20 to 40 with an increased incidence during the past de-
years. Localisation of infection was: chorioamnio- cade. Little is known about the etiology or patho-
titis (28 cases), urinary tract infection (22 cases), genesis of this uncommon malignancy. The ob-
postpartum endometritis (12 cases: 10 after ce- jective of this paper is to present a case of
sarean section, 2 after spontaneous birth), infec- primary serous peritoneal carcinoma diagnosed
tion at the wound site (8 cases), infection with histopathologically.
Clostridium difficile (4 cases), catheter infection Methods and results: The patient is a 59 old
(2 cases). woman with hepatitis C and cirrhosis, anemic,
Germs involved were: E coli 28 cases, Klebsi- cachectic, subicteric and plurialergic.
ella 22 cases, MRSA 8 cases, Streptococcus 12 The clinical exam and the CT revealed impor-
cases, 2 cases of Serratia, Clostridium difficile 4 tant ascites and multiple intraperitoneal tumoral
cases, Proteus miranbilis 6 cases, 2 cases Acineto- mases. A total extrafascial hysterectomy and bilat-
bacter. eral salpingo-oophorectomy with pelvic and
Associated pathology was present in 22 cases paraaortic lymph node dissection and omentec-
and was represented by: incompetent cervix (8 tomy was performed. The cytoreduction was lim-
cases: 4 with cerclage and 4 with vaginal pessary) ited by the biologic condition of the patient.
uterine malformations (4 cases), hypertension (2 The surgical staging was stage IIIB. The histo-
cases), DPPNI (2 cases), systemic lupus erietema- pathologic diagnosis was: primary serous perito-
tos (2 cases), type 2 diabetes (4 cases). neal carcinoma with high-grade of malignity (G3)
All patients were treated with antibiotics ac- and invasion of the uterine, tubal and cervical
cording to the sensitivity of the pathogen that has serosa and both ovaries. The immediate postop-
been identified when and with broad-spectrum erative evolution was favorable, but due to the
advanced stage, high-grade malignity and associ-
antibiotics when incriminated germs were not
ated pathology of the patient the prognosis is
identified.
poor.
Conclusions: The incidence of NI in our
Conclusion: In conclusion we presented a
study was 2% (in various European countries the
rare case of primary serous peritoneal carcinoma
rates vary between 3,5% and 11,6%), witch
diagnosed histopathologically at woman with
means that this entity is still under-diagnosed and
hepatitis C and cirosis.
under-reported. The study identified some risk
factors and the most common pathogens, provid-
ing necessary data for an effective infection con- (67) Preexistent
trol program. components of metabolic
syndrome and high risk
(64) Primary serous
pregnancy
carcinoma of the
peritoneum an uncommon Oana Bodean1,2, Roxana Bohiltea2,
Octavian Munteanu2, Diana Voicu1,
malignancy Stefan Arama2, Monica Cirstoiu2
Cristina Vasiliu1,2, Simona Elena Albu1,2, 1
Ana Badanoiu2, Mara Carsote1,3 Romania
2
1
University of Medicine and Pharmacy Carol University of Medicine and Pharmacy Carol
2
University Emergency Hospital, Bucharest,
Romania Background: Physiologically, pregnancy in-
3
National Institute of Endocrinology C.I. Parhon, duces metabolic changes similar to those occur-
Bucharest, Romania ring in metabolic syndrome (MS). Preexistent
components of MS cause major complications
Objective: Carcinoma of the peritoneum is a such as gestational diabetes (GD) or preeclampsia
rare condition with a poor survival rate, even af- (PE). Preventing such complications is a subject of
ter treatment with debulking surgery followed by intense research, and easy to apply screening
systemic chemotherapy. It is a disease of older methods are needed in order to identifying pa-

ABSTRACTS
tients at risk. Insulin resistance, abnormal lipid event subsequent the caesarean section. The pa-
levels, obesity and hypertension are part of the tient had a positive familial history for thrombotic
MS. This study hypothesizes that the presence of events and a cavernous sinus thrombosis in per-
components of the MS prior to conception in- sonal history. Prophylactic treatment with low
crease the risk of maternofetal complications. molecular mass heparins throughout pregnancy
Method: We have retrospectively analyzed was applied. At 31 weeks gestation, iatrogenic
169 pregnant patients with no history of cardio- premature termination of pregnancy by cesarean
vascular disease, GD or PE who delivered in our for intrauterine growth restriction 3 weeks, de-
hospital in 2015 and have been diagnosed with compensated chronicle fetal distress, low objec-
obesity (n=66), GD (n=39) and PE (n=64) dur- tive biophysical fetal score and absent diastolic
ing the current gestation. Pre-gestational blood flow in the umbilical artery on ultrasound exam,
pressure, glycemic and lipid values were corre- was decided. Three days postoperative in the
lated to those of control patients. context of paresthesias, color and temperature
Results: Patients who had PE/GD had an in- modification of the right leg and abolished popli-
creased weight and had higher triglycerides teal pulse, arterial thrombosis is suspected, being
(>/=150mg /dl, n=103) and lower HDL choles- confirmed by angiographic-CT. Cardiovascular
terol (<50mg/dl) one year prior to pregnancy conservative treatment was successful. By consid-
compared to controls. ering the particularities of the presented case we
Moreover, obesity, PE and a large fetus meant discuss the occurrence of arterial thrombosis
an increased risk for cesarean section compared postpartum in the context of confirmed thrombo-
to healthier slimmer controls (total cesarean birth philia by reviewing the specialized literature.
rate=70%).
Conclusion: Creating a metabolic profile pri- (91) Retrospective study
or to pregnancy or in early gestation is useful for
identifying and proper managing pregnancies of regarding management of
increased risk. vulvar cancer in the
Department of Obstetrics
(83) Postpartum aortic
and Gynecology of
bifurcation thrombosis on
Emergency University
the background of
Hospital Bucharest
thrombophilic disorders
Laura-Gabriela Coman1, Octavian
Roxana Elena Bohiltea1, Monica Mihaela Munteanu1,2, Roxana Bohiltea2,
Cirstoiu1, Natalia Turcan2, Horia Monica Cirstoiu2
Muresian1, Silvia Condru2, Elvira Bratila1 1
1
Department of Obstetrics and Gynecology,
2
Clinical Emergency Hospital, Bucharest, Emergency University Hospital Bucharest,
Romania Romania
Two main causes of arterial thrombosis are Objective: This study was undertaken in or-
known: first-atherosclerosis, extensively studied, der to assess the rarity of vulvar cancer and point
and the second-atrial fibrillation. The absence of out the importance of interdisciplinary manage-
any risk factors and the occurrence at young age ment of patients diagnosed with this type of neo-
of a thrombotic event requires us to investigate plasia in order to improve its prognostic.
possible other conditions, including inherited Methods: Medical records of all patients, di-
thrombophilia which is characterized by a num- agnosed with vulvar cancer in the Department of
ber of genetic disorders that increase the risk of Obstetrics and Gynecology of University Emer-
thromboembolic disease. The role of thrombo- gency Hospital of Bucharest between 1.01.2010
philia in the occurrence of arterial thrombosis is and 08.03.2016 were retrospectively reviewed.
inconsequential; this disorders being character- We analyzed the incidence and methods used in
ized by the tendency of developing venous establishing the diagnostic, the histopathological
thrombosis. We present a case of a 29 years preg- subtypes of cancer, stage and the management
nant woman who presents an arterial thrombotic used in all patients in order to determine the es-

ABSTRACTS
sential factors of prognostic. Data was obtained ment of pregnancies complicated by premature
from medical records and the Statistics Depart- rupture of the fetal membranes is influenced by
ment of University Emergency Hospital in Bucha- the gestational age, the availability of neonatal in-
rest. The statistical analysis was performed using tensive care, the presence or absence of mater-
SPSS and Microsoft Excel 2010 . nal/fetal infection, the presence or absence of la-
Results: Between 1.01.2010 and 08.03.2016 bor, the stability of the fetal presentation and fetal
17 patients were diagnosed and underwent a sur- heart rate tracing pattern, the probability of fetal
gical procedure in the Department of Obstetrics lung maturity, and cervical status. We present the
and Gynecology of University Emergency Hospi- case of a patient aged 45 years with primary infer-
tal of Bucharest. 70.58% (n=12) of these patients tility who presents rupture of the fetal membranes
were diagnosed with squamous carcinoma, and in the context of a dichorionic, diamniotic twin
the others with adenocarcinoma (n=5). Clinical pregnancy, 20 weeks of gestation, obtained by in
examination and vulvar biopsy following vulvos- vitro fertilization. Ultrasound exam revealed first
copy were performed in all cases. Most patients fetus with oligohydramnios in cranial presenta-
had advanced stage vulvar cancer (according to tion; the second fetus with normal development.
FIGO International Federation of Gynecology It is decided an expectant management and an
and Obstetrics staging for carcinoma of the vul- acute alternative tocolytic therapy with -mimetics
va): stage III (n=7, 58,33%), stage II (n=4, 33, and a short course of 48 hours of atosiban was
33%), stage I (n=1, 8,33%). 9 patients underwent associated with calcium-channel blockers, pro-
neoadjuvant radiotherapy and total vulvectomy gesterone and corticosteroids. Under specified
with radical inguinal lymphadenectomy. We also treatment an extension with 7 weeks is obtained.
observed that 16 patients had multiple comor- During this period first fetus develops due to oli-
bidities: diabetes mellitus (n=7), arterial hyper- gohydramnios successive ventriculomegaly and
tension (n=9) and obesity (n=4) and required hydrocephaly. At 27 gestational weeks first fetus is
interdisciplinary management prior and after sur- delivered naturally and taken over by the neona-
gery. tal intensive care service. The sectioning of the
Conclusion: Vulvar cancer represents a chal- umbilical cord at his uterine emergence is prac-
lenge for specialists in gynecology and general ticed and the undelivered the placenta is aban-
surgery because it reveals major prognostic impli- doned in utero. At 28 weeks of gestation is deliv-
cations. Notwithstanding, according to this study, ered naturally in cranial presentation the second
it is a rare condition with favorable prognostic if fetus. Unlike the first newborn whose perinatal
the diagnosis and radical treatment are performed development has been influenced by the conse-
in early stages. quences of premature ruptures of the membranes
culminated with fetal death, the second fetus
(92) The abandonment in with intact membranes and intrauterine develop-
ment prolonged with eight weeks presented a
utero of the placenta in normal neuro-psychiatric development during
prolonged twin pregnancy the first 5 years of follow up. The expectant man-
agement of the cases with premature rupture of
complicated by premature membranes is recommended in the absence of
rupture of membranes complications. The abandonment of the placenta
is exceptional after the delivery of the first fetus of
Roxana Elena Bohiltea1, Monica Mihaela a twin pregnancy, only few similar cases being re-
Cirstoiu1, Natalia Turcan2, Elvira Bratila1, ported in the literature of this domain.
Alexandru Baros1, Octavian Munteanu1,
Diana Voicu2, Oana Bodean2
1
2
Romania
Premature rupture of fetal membranes is as-

sociated with a substantial fetal morbidity and
mortality. The pathogenesis of spontaneous mem-
brane rupture is not completely understood, but
is considered to by multifactorial. The manage-

ABSTRACTS
(95) Genodermatoses and (99) Interdisciplinary

the genetic predisposition management of a patient
for neoplasia with a rare mammary tumor
Cerasela Paraschiv1, Marius Paraschiv2, Ioana Paltineanu1, Irina Stavarache1,
Roxana Bohiltea3,4, Laurentiu Camil Octavian Munteanu1,2, Dragos Davitoiu3,
Bohiltea1 Maria Sajin4, Monica Cirstoiu2
1 1
Department of Medical Genetics, University of University of Medicine and Pharmacy Carol
Medicine and Pharmacy Carol Davila, Bucharest, Davila, Bucharest, Romania
2
Romania Department of Obstetrics and Gynecology,
2
Clinic of General Surgery, Emergency Hospital Emergency University Hospital Bucharest,
Bagdasar Arseni, Bucharest, Romania Romania
3 3
University of Medicine and Pharmacy Carol Department of General Surgery, Emergency
Davila, Bucharest, Romania University Hospital, Bucharest, Romania
4 4
Department of Obstetrics and Gynecology, Department of Histopathology, Emergency
Emergency University Hospital, Bucharest, University Hospital, Bucharest, Romania
Romania
Objective: We report the case of patient who
Objective: Malignant tumors are associated was admitted in the Department of Obstetrics
with several inherited dermatological diseases and Gynecology of University Emergency Hospi-
called genodermatoses-skin diseases. The diag- tal for a mammary tumor with benign clinical, ul-
nosis of skin features associated can facilitate the trasound and mammographic characteristics di-
diagnosis of genodermatoses with malignant po- agnosed with breast cancer after an extensive
tential and initiate the screening for tumors. histopathological examination with immunohis-
One of these genodermatosis is neurofibro- tochemistry analysis. The aim is to highlight the
matosis with two forms: type 1(peripheral), or importance of interdisciplinary management of
type 2(central). NF1 is an autosomal dominant patients with mammary tumors.
disease (17q11.2), characterized by multiples Method: We report the case of a 42 years old
neurofibromas spread along the nerves, caf-au- woman who was admitted in the Department of
lait spots, Lisch nodules on iris and malignant tu- Obstetrics and Gynecology of University Emer-
mors. gency Hospital Bucharest for a palpable right
Method: We selected 20 patients with NF1 breast tumor. She denied any significant family or
according to NIH criteria and with neurogene be- personal medical history. The tumoral mass, lo-
nign intratoracic tumors. cated in the upper-outer right quadrant of the
At 15% of patients with NF1 (3 from 20) ap- right breast, measured approximately 5/4/4 cm
pears malignant peripheral nerve sheath tumors and was well circumscribed, non-adherent, with
(MPNSTs) from benigne neurofibromas which in- mobility on superficial plans. The mammography
crease mortality. These malignancy is produced showed a well circumscribed mass, with hyper-
by biallelic loss of NF1 gene function, which acts echoic homogenous tissue and no spiculation.
like a tumoral suppression gene. NF1 gene pro- During ultrasound examination the tumor ap-
duced a neurofibromin, an ATP-ase with a key peared anechoic with interior vegetative tissue.
role in cellular proliferation. The MPNSTs tumors Intraoperative we extirpated the tumoral mass
have a complex histopathological features. which was very adherent to the great pectoral fas-
Results and conclusions: The management cia. Also, specimens for biopsy were obtained
of neurofibromatosis is complex and implies a during surgery and the extemporaneous exami-
multidisciplinary approach: surgical, chemiother- nation showed a malignant papilloma. However,
apy and radiotherapy. The family history and the after an extensive histopathological examination
genetic counseling for genodermatosis must be with immunohistochemistry analysis she was di-
important steps for malignant tumor surveillance. agnosed with intraductal papilloma with areas of
atypical hyperplasia and ductal carcinoma in situ.
She received adjuvant radiotherapy and anti-es-
trogen therapy.
Conclusion: The diagnosis of breast cancer
was established rapidly in an early stage due to
efficient collaboration between specialists in: Ob-

ABSTRACTS
stetrics-Gynecology, General Surgery, Histopa- (105) The use of ultrasound

thology, Oncology and Radiotherapy. In order to
improve prognostic interdisciplinary manage- and Doppler examination in
ment is essential in patients with breast tumors. diagnosis, treatment and
follow-up of gestational
(104) Diaphragmatic trophoblastic disease
relaxation in adult patients
Claudia Mehedintu, Mihaela Bujor,
case report Florin Isopescu, Monica Mihaela
Georgiana Fotache1, Andrada Evtodiev2, Cirstoiu, Elvira Bratila, Roxana Bohiltea
Ion Jentimir1, Ciprian Bolca1 University of Medicine and Pharmacy Carol
1
Pneumology Institute Marius Nasta, Bucharest, Davila, Bucharest, Romania
Romania
2
Clinical Emergency Hospital, Bucharest, The gold standard for evaluation of first tri-
Romania mester pregnancy is considered to be ultrasound
imaging, which can give a specific diagnosis in
Relaxation, eventration or diaphragmatic pa- case of abnormal early pregnancy bleeding. Com-
ralysis represents the elevation of one leaf of an plete or partial hydatidiform can be often diag-
intact diaphragm. This condition is rare and oligo- nosed using ultrasound examination, especially
symptomatic (digestive, respiratory and cardiac), when correlated to clinical symptomatology.
and it is the result of aplasia, atrophy or muscular Objective: To evaluate the clinical utility of
paralysis. The differential diagnosis should be sonography with uterine arteries Doppler exami-
kept in mind. The surgical approach of this condi- nation in the diagnosis treatment and follow-up
tion is recommended when alterations in respira- of gestational trophoblastic disease (GTD).
tory function are found. Methods: We performed a national, multi-
Objectives: A 53 years old man was present- center, retrospective trial between January 2015
ed with digestive, cardiac and pulmonary symp- and December 2015. We assessed 19 cases of
tomatology, with no history of medical impor- GTD and the analysis included clinical and ultra-
tance. The CT scans showed an elevated left sound findings, uterine arteries Doppler exami-
hemidiaphragm, with the paramediastinal sec- nation and HCG follow up. Ultrasound and
ondary ascension of the stomach, spleen and left Doppler examinations were performed in order
colon, without any other suspect lesions. The to diagnose the presence of molar tissue, detect
ventilatory tests showed a moderate mixt disfunc- invasive disease, assess disease recurrence, and
tion with decreasing VEMS to 43.1% and VC to monitor the efficacy of chemotherapy. For the
36.7%. Doppler examination we compared to a control
Methods: We decided a classical approach by group of normal early pregnancies.
left thoracotomy with the plication of the dia- Results: Of the 19 patients with GTD, 11 had
phragm. Because there is a tendency to relapse, a a classic hydatidiform mole (CHM), 5 a partial hy-
polypropylene net was used to strengthen the datidiform mole (PHM), 2 an invasive hydatidi-
area. form mole (IHM) and 1 had choriocarcinoma.
Results and Conclusions: The patients post- Ultrasound showed abnormal molar tissue inside
operative ventilatory function was improved, the the endometrial cavity in all cases of CHM, while
diaphragm lowered to the anatomic position and in cases of IHM and choriocarcinoma it revealed
the symptomatology ceased. He left the hospital soft tissue invasion and cystic vascular spaces
5 days after surgery under analgesic treatment within the myometrium. The cases of PHM had a
and having a favorable evolution. hydropic placenta with a concomitent fetus.
It is important to recognise this condition be- Doppler waveforms showed low resistive indices
cause of its oligosymptomatology and the reper- of 0.54 for CHM, 0.55 for PHM, 0.25 for HIM,
cussions it might have left untreated or incorrectly 0.23 for choriocarcinoma, and 0.65 for normal
diagnosed. In this case, we believe that the surgi- pregnancies. The abnormal sonographic and
cal approach has greatly improved the patients Doppler findings in invasive disease were suc-
quality of life. cessfully resolved with chemotherapy.
Conclusions: Ultrasound and Doppler imag-
ing is especially useful in determining the invasion
character and recurrence of gestational tropho-

ABSTRACTS
blastic disease, as well as its chemotherapeutic ment. The postoperative evolution was simple.
treatment follow up. The follow up of this case is done from 3 to 6
months in the first 2-3 years and then annually up
(111) Management of to 10 years.
borderline tumors of the

ovary. Case report. (112) Medial vs. lateral
Filantropia experience parapatellar approach in
Laura Mihaela Mustata1, Gheorghe total knee arthroplasty for
Peltecu1,2, Gica Nicolae1 severe valgus knees: case
1
Filantropia Hospital, Bucharest, Romania report and literature review
2
Davila, Bucharest, Romania Andrei Costin Tutovanu1, Adrian
Ciobanu1, Mihail Eremia1, Alexandru
Borderline ovarian tumors (BOT) represent a Chiribau1, Emil George Haritinian1,2
group of low malignant potential tumors, approx- 1
imatively 8-10% of all ovarian tumors. The inci- Orthopedic Clinic Hospital, Bucharest, Romania
2
dence of these tumors is situated between 1,8- University of Medicine and Pharmacy Carol
4,8/100.000 women/annually. The median age of Davila, Bucharest, Romania
the diagnosis of these tumors is usually 10 years
Objective: An ideal approach for valgus knees
earlier than the ovarian cancer. Surgical treatment
should provide adequate exposure with minimal
for these patients includes conservative manage-
complications. Medial parapatellar approach is
ment considering the fact that most of these
the most common approach in total knee arthro-
women are diagnosed at a fertile age. Also the
plasty (TKA) including valgus knee cases but some
fertility sparing treatment is associated with close
surgeons consider the lateral approach to be a
follow up, without chemotherapy or radiothera-
better option. The objective of this study is to
py.
compare the medial vs. lateral approach for total
Pseudomyxoma peritonei it is a rare condi-
knee replacement in severe valgus knees.
tion, characterized by collection of gelatinous Methods: We performed a literature review
material in pelvis and abdomen with mucinous (PubMed, ScienceDirect) searching for TKA for
implant on the peritoneal surfaces. Firstly this severely deformed valgus knee using a medial ap-
condition was applied in cases of mucinous tu- proach and also comparisons with the lateral ap-
mors of the appendix that spread into the perito- proach.
neum and also in ovaries. Standard treatment for We present a difficult case with severe post-
PMP is repeated surgical debulking for symptom- traumatic valgus knee osteoarthritis operated us-
atic disease. Although randomized trials have not ing a medial approach and a pie crusting release
been conducted, five-year survival rates of 70 to of the lateral structures with a varus-valgus con-
86 percent have been reported for highly select- strained prosthesis.
ed patients. Results: In most studies the use for TKA in val-
Objective an Methods: We report a case of gus knees with a standard medial approach in
voluminous bilateral borderline ovarian tumors contrast to lateral approach with anterior tibial
treated in our hospital. A 41 years old woman, tuberosity osteotomy (TTO) showed no statisti-
presents with voluminous pelvi-abdominal mass cally significant differences in terms of clinical re-
and is suspected with ovarian tumor and ascites. sults.
The particularity of this case is that the macro- The lateral approach allows for a good lateral
scopic aspect and the grade of invasion of the tu- release, but the main disadvantage is the occa-
mor is similar to a case of pseudomyxoma perito- sional need for TTO and also the more frequently
nei. The patient is treated surgical in our hospital encountered skin healing issues compared with
with total hysterectomy, bilateral anexectomy, ap- the medial approach.
pendectomy and evacuation of the mucinous The medial approach is more familiar for most
fluid in the peritoneum. The histopathological surgeons and can be used successfully to perform
result show two voluminous ovarian tumors with the necessary releases. Using a medial approach
mucinous content, invading the uterus, the ap- for severe valgus cases usually involves extensive
pendix and the peritoneum cavity. No chemo- soft tissue dissection and may devitalize the pa-
therapy or radiotherapy was added to her treat- tella.

ABSTRACTS
Preoperatively our patient had a HKA (Hip continued at least until late second trimester and
Knee Ankle) of 146.4 (33.6 degrees of valgus) infant vaccination should be postponed 3 to 6
and a ROM of 90-10-0. Postoperatively the HKA months.
was 177 (3 of valgus) with a ROM of 100-0. The Vaginal delivery is safe for most patients. Cae-
mean modified Knee Society clinical score im- sarean section is only required for obstetrical indi-
proved from 34 preoperatively to 90 points post- cations.
operatively, and the mean functional score im- Risk of relapse in all CD patients is higher
proved from 32 to 80 points. postpartum and a medical exam is best sched-
Conclusion: The medial approach is a useful uled at 4 to 6 weeks after delivery.
approach for TKA even in severe valgus knee de- Conclusions: Disease control prior to con-
formity offering good results and avoiding some ception dictates the pregnancy outcome. Early
of the disadvantages of the lateral approach. evaluation by gastroenterologist, maternal-fetal
medicine specialist and obstetrician is recom-
(118) Management of mended to plan appropriate pregnancy manage-
ment, follow-up and mode of delivery.
pregnancy in Crohn disease
Brindusa Ana Cimpoca1, Gheorghe (126) Surprising finding
Peltecu1,2, Anca Maria Panaitescu1,2 during hernia repair
1
Filantropia Clinical Hospital, Bucharest, a case report
Romania
2
University of Medicine and Pharmacy Carol Nicolae Bacalbasa1, Irina Balescu2,
Davila, Bucharest, Romania Radu Costin3
1
Background: Crohns disease (CD) is a chron- Davila, Bucharest, Romania
ic inflammatory bowel disease with onset during 2
Ponderas Hospital, Bucharest, Romania
reproductive age. Current therapeutic strategies 3
Ilfov County Hospital, Bucharest, Romania
achieve good control over the CD activity and
might permit fertility and a normal course of preg- Objective: to report the case of a 65 year old
nancy. patient submitted to surgery for inguinal hernia
Objective: To review the published data on repair in whom a tumoral Meckel diverticulum
pregnancy outcome in women affected by was found.
Crohns disease. Methods: the patient with no significant med-
Methods: We conducted a PubMed search ical history presented for inguinal pain and was
for reviews and meta-analyses published between diagnosed with a right inguinal hernia with signs
2000 and 2016 with the following terms, Inflam- of incarceration so he was submitted to surgery.
matory bowel disease Crohns disease in com- Results: intraoperatively in the hernia sac an ileal
bination with keywords fertility, pregnancy, loop with Meckel diverticulum was found. The
congenital abnormalities and anti-TNF thera- involved segment of the ileal loop was resected
py. and sent to histopathological studies while the
Results: We found 58 relevant studies. With continuity was re-established by an end to end
inactive disease at conception, the risk of flare is anastomosis. The histopathological examination
similar to that in non-pregnant patients and rates revealed the presence of a well differentiated
of miscarriage, stillbirth, fetal abnormalities are neuroendocrine tumor with low mitotic index.
equal to those in general population. The major- Conclusions: although a standard therapeutic
ity of women have full term normal pregnancies. approach is not well established in patients diag-
With active disease, one-third of patients nosed with asymptomatic Meckel diverticulum,
present a relapse during pregnancy or postpar- the surgeon should always be aware of the possi-
tum. In this patients the risk of miscarriage, still- bility of malignant transformation especially in
birth, growth restriction and preterm birth are elderly patients.
higher. These patients should be monitored as
high-risk pregnancies.
Most drugs used in the treatment of CD dis-
ease are safe during pregnancy with no reported
adverse outcomes. Folate supplementation is
highly recommended. Anti-TNF drugs can be

ABSTRACTS
(127) Incidental finding of peritoneal fluid so she was submitted to emer-

gency surgery.
serous ovarian carcinoma Results: intraoperatively a large ruptured
and endosalpingiosis uterine tumor with peritoneal involvement and
secondary hemoperitoneum was found. The pa-
a case report tient was submitted to total hysterectomy with
Nicolae Bacalbasa1, Irina Balescu2, bilateral adnexectomy, pelvic, para-aortic lymph
Dana Terzea3 node dissection, parietal and pelvic peritonecto-
my and segmental enterectomy. The histopatho-
1
University of Medicine and Pharmacy Carol logical studies revealed a moderately differenti-
Davila, Bucharest, Romania ated endometrial adenocarcinoma. At two year
2
Ponderas Hospital, Bucharest, Romania follow up the patient is free of recurrent disease.
3
Monza Hospital, Bucharest, Romania Conclusions: debulking surgery can be safely
applied for uterine adenocarcinomas with perito-
Objective: to report the case of lymph node neal involvement and may bring survival benefit.
involvement in endosalpingiosis. Endosalpingiosis
is a rare gynecologic condition which is character-
ized by the presence of epithelial inclusions out- (129) Left upper abdominal
side the fallopian tubes, usually diagnosed in quadrant resection as part
postmenopausal women. of tertiary cytoreduction for
Methods: we present the case of a 48 year
old patient submitted to surgery for bilateral ovar- relapsed ovarian cancer
ian tumors with preoperative suspicion of malig-
Nicolae Bacalbasa1, Irina Balescu2
nant transformation.
1
Results: a total hysterectomy with bilateral University of Medicine and Pharmacy Carol
adnexectomy, pelvic and para-aortic lymph node Davila, Bucharest, Romania
2
dissection was performed. The histopathological Ponderas Hospital, Bucharest, Romania
studies revealed the presence of a well differenti-
ated serous ovarian carcinoma associated with Objective: to demonstrate the benefits of en
bilateral endosalpingiosis associated with lymph bloc resections in the left upper abdominal quad-
node involvement. rant at the moment of tertiary cytoreduction for
Conclusions: although endosalpingiosis is a relapsed ovarian cancer.
rare condition, the recognition of this pathology is Methods: a 44 year old patient had been pre-
especially important due to the possibility of as- viously diagnosed with a stage IIIC poorly differ-
sociation of malignant pathologies such as serous entiated serous ovarian adenocarcinoma; at the
ovarian carcinomas. moment of initial diagnosis the patient was sub-
mitted to total hysterectomy, bilateral adnexec-
tomy, pelvic, para-aortic lymph node dissection
(128) Aggressive surgical and omentectomy.
approach for ruptured Results: At one year follow up the patient was
uterine adenocarcinoma diagnosed with peritoneal carcinomatosis and
she was submitted to pelvic and parietal perito-
with secondary nectomy and segmental enterectomy. At two year
hemoperitoneum follow up the patient was diagnosed with an iso-
lated recurrence in the left upper abdominal
Nicolae Bacalbasa1, Irina Balescu2 quadrant. At this time the recurrence was resect-
1
University of Medicine and Pharmacy Carol ed en bloc with parcelar gastrectomy, distal pan-
Davila, Bucharest, Romania createctomy, splenectomy and left colectomy.
2
Ponderas Hospital, Bucharest, Romania During the postoperative course the patient de-
veloped grade B pancreatic fistula which was suc-
Objective: to demonstrate the efficacy of de- cessfully treated in a conservative manner. At one
bulking surgery for ruptureduterine tumors with year follow up she is free of recurrence.
peritoneal disseminations. Conclusions: left upper abdominal quadrant
Methods: a 67 year old patient presented for resections can be safely performed as part of de-
diffuse abdominal pain associated with hypoten- bulking surgery for relapsed ovarian cancer and
sion and tachycardia. The abdominal ultrasound may improve survival
revealed the presence of a large amount of free

ABSTRACTS
(132) The relationship Methods: We searched the available litera-

ture using PubMed, ScienceDirect, Retina Medi-
between osteoporosis and cal Search for neglected locked posterior shoul-
body mass index in der dislocation.
We also present the case of a 35-year-old
postmenopausal women male with a neglected locked shoulder fracture-
Marius Vlase1, Manuela Stefana Neagu2 dislocation (over 6 months at the moment of pre-
1
sentation) and a reverse Hill Sachs defect of less
Emergency University Hospital, Bucharest, than 20 percent of the articular surface. We used
Romania the McLaughlin procedure (transfer of the sub-
2
University of Medicine and Pharmacy Carol scapularis into the anteromedial humeral head
Davila, Bucharest, Romania defect) followed by 6 weeks of shoulder immobi-
lization in an external rotation brace and physio-
Objectives: To assess the relation between therapy.
body mass index and bone mineral density in Results: There are few studies concerning this
postmenopausal women. subject, most of them case reports or small series.
Method: We performed a retrospective study The treatment options include conservative treat-
among women aged 55-83 years who addressed ment, McLaughlin procedure (standard and mod-
to the Bone Density Scan Laboratory of Universi- ified), humerus rotational osteotomy, posterior
ty Hospital of Emergency Bucharest between Oc- glenoid augmentation, reconstruction of the hu-
tober 2014 and March 2016. The bone mineral meral head with bone graft and prosthetic re-
density was tested using central DEXA (lower placement. The most common complications are
spine and hip), and the median T score recorded. recurrent dislocation and shoulder stiffness.
Body mass index was also recorded. We per- In our case the results were in concordance
formed a statistic analysis to assess the relation- with the literature, being able to obtain a stable
ship between BMI and BMD. shoulder with pain-free and acceptable range of
Results: The statistical analysis was performed motion at the 6 months follow-up.
using Pearsons correlation coefficient, with a R Conclusion: The neglected locked posterior
value of 0.8141, a strong positive correlation, shoulder dislocation is difficult to treat, so early
which means that high BMI values goes with high diagnosis is very important.
BMD scores (and vice versa). The value of R2, the The McLaughlin procedure is a good option in
coefficient of determination, was 0.6628. this pathology, in cases with humeral head defect
Conclusions: There is a proportional relation- of less than 40% and when the degenerative
ship between osteoporosis and BMI, women with changes are not very important.
low BMI being at risk of osteoporosis.
(136) Transfistular
(134) Surgical treatment of
choledocojejunostomy a
neglected locked posterior
therapeutic option in
dislocation of the shoulder:
external biliary fistula
case report and literature
review Octavia Cristina Rusu1,2, Radu Virgil
Costea1,2, Mohsen Hasouna1,2,
Emil George Haritinian1,2, Alexandru Chirca1,2, Cristian Constantin
Adrian Ciobanu2, Roman Popescu2, Popa1,2, Stefan Ilie Neagu1,2
Mihai Eremia2, Andrei Tutovanu2 1
Second Department of Surgery, University
1
University of Medicine and Pharmacy Carol Emergency Hospital, Bucharest, Romania
2
Foisor Clinical Hospital of Orthopedics, Davila, Bucharest, Romania
Traumatology and Osteo-Articular Tuberculosis,
Bucharest, Romania Objective: External biliary fistula is a matter of
concern for biliary tract surgery.
Objectives: The locked posterior shoulder Methods: We present a case of a 39 years old
dislocation is a relatively uncommon pathology patient, treated in our clinic during December
and we want to evaluate the treatment options. 2015 - April 2016. The patient was admitted for

ABSTRACTS
jaundice and asthenia. Laboratory tests showed (138) Using the lateral
leukocytosis, hepatic cytolysis syndrome, in-
creased bilirubin, and inflammatory syndrome. cephalogram radiograph as
Abdominal ultrasound revealed dilated intrahe- a predictor of difficult
patic bile ducts, discretely dilated common bile
duct (CBD), and thick wall gallbladder containing
airway in a Down syndrome
a gallstone of 20 mm. patient
During surgery we discovered gangrenous hy-
dropic lithiasis acute cholecystitis and inflamma-
George Gabriel Moldoveanu, Emilia
tory block including hepatic pedicle, making im- Severin, Cristian Funieru, Andreea Paun
possible to visualize the CBD. Anterograde University of Medicine and Pharmacy Carol
cholecystectomy and external transcystic biliary Davila, Bucharest, Romania
drainage was performed. Postoperative evolution
was favorable and biliary drainage was about 600 Objectives: According to previous studies,
ml / 24 h. complications of anesthesia are more likely to oc-
Nine days after surgery cholangiography cur in individuals with Down syndrome because
showed distal CBD stenosis, which doest allow of soft tissue and skeletal changes encountered in
the passage of contrast into the duodenum. ERCP this type of patients. A safe anesthesia requires
confirmed the distal CBD stenosis. Wide papilos- evaluation of the patient. The study aimed to
fincterotomy was performed without possibility evaluate craniofacial skeleton abnormalities using
of passing a stent through biliary stenosis or re- lateral cephalometric radiograph (LCR) and was
moving lithiasic material from the choledoc. After followed by comparing these paraclinical param-
that we performed MRI of biliary ducts and ab- eters with the clinical ones.
dominal CT, which revealed distal CBD stenosis, Methods: A 12-year-old male, cytogenetically
with no evidence of any neoplastic lesions at this diagnosed with mosaic Down syndrome, was ex-
level. We still tempted duct stenting twice; duo- amined clinically and paraclinically in order to as-
denal papilla biopsy was performed without evi- sess the difficulty of the endo-tracheal intubation.
dence of malignancy. To fit the patient into a risk group, there were
During the hospitalization the patients evolu- measured the weight, the height and the head,
tion was favorable with no clinical symptoms and neck and abdominal circumferences. Patil and
improved results of biological samples, but with Savva tests were used in order to determine the
persistent cholestasis syndrome; biliary drainage thyromental and sternomental distances. The in-
was about 1.000 ml/24 h. traoral evaluation consisted in measuring the
Eleven weeks after the first operation we per- maximal mouth opening and the dental mobility.
formed transfistular choledocojejunostomy side The Mallampati score was determined as well.
to side (omega loop), Braun anastomosis and LCR was used to measure the inclinations of the
transanastomotic drainage a la Witzel. Postopera- upper and lower incisors, the effective length of
tive evolution was uneventful, with the extraction the mandible (Kdl-Gn), the atlanto-occipital gap
of transfistular drainage tube after 24 days; the (C0-C1), the C1-C2 gap (atlas - axis) and the
patient left the hospital with normal values of bio- Delegue maxillo-pharyngeal angle (MA-PA). Fi-
logical samples. nally, there were correlated the larynx position on
Conclusion: Transfistular choledocojejunos- LCR with the thyromental distance.
tomy represents a therapeutic option in case of Results: The following results were obtained:
postoperative external biliary fistula. B.M.I. 13,5 kg/m, abdominal circumference 65
cm, neck circumference 29 cm, head circumfer-
ence 50 cm. The maximum mouth opening was
limited to 34 mm. The thyromental distance was
5.5 cm, sternomental distance 15 cm and the
Mallampati score II (not difficult to intubate). On
the LCR, the inclinations of the upper incisors was
71.5 and for the lower incisors - 96, the effec-
tive mandibular lenghth (Kdl-Gn) was 120 mm,
the atlanto-occipital gap - 9 mm, C1C2 gap - 8
mm and the maxillo-pharyngeal angle was 84.
Conclusions: From this study, it was conclud-
ed that the LCR is a valuable tool for the preop-

ABSTRACTS
erative examination and, it brings additional in- Conclusion: Although the medical literature
formation which can be correlated with the reports only few cases of retroperitoneal lipomas,
clinical examination in order to establish the dif- the treatment protocol consists of a curative low-
ficulty degree of the intubation. This type of com- risk surgical procedure, followed by the full re-
prehensive approach is particularly important in covery of the patient. A correct and complete
patients with Down syndrome taking into ac- excision guaranties a small risk of recurrence.
count their physiological and pathological partic-
ularities.
(161) Malnutrition risk and
(160) Misleading case report associated factors for the
of an abdominal lipoma: surgical patient
anterior or retroperitoneal? Maria Nitescu1,3, Daniela Pitigoi1,3,
Daniela Gheorghe2, Marina Otelea1,
Maria Cristina Hoara, Alina Nicoleta
Florentina Ligia Furtunescu1
Ivascu
1
3
National Institute for Infectious Diseases Prof.
Objective: Lipomas are mesenchymal tumors Dr. Matei Bals, Bucharest, Romania
characterized by the abnormal proliferation of
adipocytes. We describe a case of retroperitoneal Objectives: Assessing malnutrition risk and
lipoma in a class III obese patient. associated factors in patients with surgical pathol-
Lipomas occur in almost all parts of the body ogy by analyzing their demographic and behav-
where fat normally exists, such as the trunk, limbs,
ioral profile and the correlation between morbid-
mediastinum and pelvis, but are rarely found in
ity profile, clinical severity and nutritional risk
the retroperitoneal space. In April 2016, the pa-
score.
tient, a 43-year-old woman, without a significant
Method: Cross-sectional descriptive study, on
medical record and no abdominal symptoms, but
a sample of 211 patients, admitted in the General
experiencing a mild discomfort in the left hypo-
Surgery Department of Colentina Clinical Hospi-
chondriac region, was referred to our surgery unit
tal in Bucharest, between January and April 2015.
for further investigation of an anterior abdominal
The following data were recorded: demographic
wall lipoma suspected on a CT investigation per-
data, behaviors which may influence nutritional
formed in March 2016. Nevertheless, the imagis-
tic description was one of a 9/10/11 cm tumor status, personal pathological medical history,
spread all over the left lumbar region. Due to the number of hospitalizations in the last year, ele-
morbid obesity, the clinical examination was in- ments of clinical severity (length of current stay in
conclusive. There were no signs of peritoneal ir- hospital, number of treatments administered,
ritation, neither of pain. presence of nosocomial infections, new admis-
Methods and Results: Given the fact that the sions after 30 days, condition upon discharge).
surgical team was expecting to find an anterior The data were collected using a questionnaire ad-
abdominal wall lipoma, a midline incision was ministered with the interview method, and the
performed. Though, the intraoperative finding malnutrition risk assessment has been performed
was one of a retroperitoneal ferm-elastic consis- using the MUST (malnutrition universal screening
tency tumor, very suggestive for a lipoma. A com- tool) questionnaire. Data were statistically pro-
plete surgical excision followed. A histological cessed with the SPSS software.
confirmation is expected. The postoperative evo- Results: 57.3% of patients were women and
lution was favorable and the patient was dis- 42.7% of patents were men (N=90). The average
charged showing no signs of complications. age in men was significantly higher than in wom-
Discussions: Differential diagnosis of an an- en (62.71 years vs. 56.21 years, p = 0.002). In
terior abdominal wall mass can be made with: the studied sample, 54.4% of subjects showed a
desmoid tumors, leiomyomas, soft tissue sarco- high risk of malnutrition (MUST 2). The nutri-
mas and rhabdomyosarcomas, whilst the one of tional risk score varied from 0 to 6, reaching an
the retroperitoneal tumor can be made with: li- average value of 1.69 and a mean of 2.
posarcomas, rhabdomyosarcomas, retroperito- Malnutrition risk increased with age (r =
neal lymphadenopathies, lymphomas and renal 0.280, p <0.001), with positive and significant
angiomyolipomas. correlation between nutritional risk score and

ABSTRACTS
number of associated diseases (r=0.280, Results: The dissection and preservation of

p<0.001), number of previous hospitalizations the inferior vena cava, portal vein and right renal
(r=0.295, p <0.001), length of hospital stay pedicle were possible but the close contact of su-
(r=0.194, p-0.005) and number of administered perior mesenteric artery required its segmental
drugs (r=0.251, p<0.001). resection with termino-terminal anastomosis. The
Conclusions: Our study shows that patients postoperative antithrombotic therapy consisted
admitted for a surgical pathology are under a mal- of Zibor, Vessel due, Ilomedin and Dextran.
nutrition risk and this leads to a longer hospital- Conclusions: Surgery for retroperitoneal tu-
ization period on average and a high number of mor requires abdominopelvic CT scan completed
administered drugs, bearing on healthcare costs. by MRI for the most accurate identification of the
Implementing malnutrition screening upon tumor rapport with nearby organs and large ves-
admission allows to identify risk patients and to sels. The final decision should be chosen intraop-
initiate certain measures contributing to the im- eratively. The intimate rapport of vascular struc-
provement of clinical results and to the reduction tures warns the surgeon about the necessity of
of costs associated with medical care of such pa- vascular reconstruction which may rise serious
tients. treatment problems, for prevention or treatment
of potential lethal complications.
(165) Surgery with vascular
reconstruction for extensive (166) Charcot foot IV
retroperitoneal tumor with Brodsky surgical solution
important vascular Claudiu Gabara1, Iozefina Botezatu1,
relations Case report Rodica Marinescu1,2, Dan Laptoiu1,2,
Andrei Bunea1, Stefan Ciumeica1
Matei Mandea1, Ruxandra Ioana 1
Department of Orthopaedics and Traumatology,
Calapod1, Maria Tronaru1, Doina Colentina Clinical Hospital, Bucharest, Romania
Hrehoret2, Mirela Patricia Sirbu-Boeti2, 2
Irinel Popescu2 Davila, Bucharest, Romania
1
Davila, Bucharest, Romania Objective: Charcot neuropathic osteoar-
2
Institute of Digestive Diseases and Liver thropathy associated foot deformity can result in
Transplantation Fundeni, Center of General joint instability, ulceration, amputation. Recon-
Surgery and Liver Transplantation Dan Setlacec structive surgical intervention is a useful treat-
Bucharest, Romania ment option for the patient who has severe mus-
culoskeletal deformity and often avoid ampu-
Objective: Retroperitoneal tumors often be- tation.
come symptomatic only at impressive dimensions Methods: We report the case of a 47-year-old
when they developed tight contact with impor- man who presented to our department in March
tant vascular structures. The histopathological di- 2016 with complaints of vicious position of right
agnosis and detection of tumor origin are possible foot, marked functional impotence, important
only by biopsy, sometimes after surgical resection, swelling, ulceration of right foot and ankle pain.
when feasible, these being significant in adjuvant From personal history, we notice poorly con-
therapeutical decision. trolled diabetes, over than 10 years; stage IV pe-
Methods: Here it is presented the clinical ripheral arteriy disease and diabetic polyneurop-
case of a 64 years old patient investigated by CT athy on daily insulin and Metforminum treatment,
and MRI exams for diffuse abdominal pain and morbid obesity. Physical examination showed:
flatulence. She was diagnosed with massive retro- extreme vicious position of right foot, varus 90
peritoneal tumor predominant on the right side on the rest of the ankle, skin infection and subcu-
with left extension being in intimate contact with taneous perforating the front side of the ankle
the inferior vena cava, portal vein, right renal and half side of the plant-foot, low local toes tem-
pedicle and the superior mesenteric artery. At perature, erythema and cyanosis on fingers I,II,III.
laparotomy the surgical resection was appreciat- Laboratory tests: leukocytosis, inflammatory syn-
ed as feasible due to identification of a cleavage drome, hyperglycemia (HbA1c=8.6 mmol/L),
plan between the tumor and vicinity tissues. bacteriological examination of the lesion found
Pseudomonas aeruginosa. Preoperative foot x-

ABSTRACTS
ray: Charcot foot with peritalar subluxation and Methods: We present the case of a 41-year-
hindfoot and midfoot remodeling. Right foot CT- old woman who was admitted to the clinical hos-
scan: Charcot neuropathic osteoarthropathy with pital Prof. Dr. Panait Sirbu Bucharest in April
sequels to the tarsus and ankle joint, (stage 2016. She was completely asymptomatic, with no
3-Eichenholtz), amputation of IV-V toes and pos- history of pain. The ultrasound scan revealed the
sibly cuboid. Our diagnosis was: sequelae of corpus of the uterine in the ante flexion position,
Charcot right foot, peritalar subluxation, poorly an intraparietal formation about 5cm in diameter
controlled type 2 diabetes complicated with pe- and another posterior of 3/4cm (suggestive for
ripheral arteriy disease, polyneuropathy and mor- uterine myomas) and an endometrial polyp. The
bid obesity. We performed right tibial-calcaneal right adnexa examination suggested hydrosal-
arthrodesis with intramedullary rod, negative pinx.
pressure therapy and bandages every 2-3 days Having the informed consent of the patient, a
with non-medicated tulle dressing of a water re- laparoscopy was performed. It revealed multiple
pellent polyester tulle impregnated with fatty uterine formations with anterior and posterior
acids(Atrauman) with favorable postoperative origin from 5 cm to 1.5 cm in diameter that
evolution and discharged after 33-days with reha- proved to be endometriomas. Moreover, a pseu-
bilitation recommendations and antibiotics, pain- do cyst probably of adhesion origin with 10 cm
killers, anticoagulants, vasodilators, appropriate diameter was found among multiple peritoneal
diabetes treatment. Postoperative x-ray: ankle endometriosis lesions.
arthrodesis with trans-calcaneal intramedullary Conclusion: Endometriosis presents multiple
rod. aspects. Even though multiple lesions can be ob-
Conclusions. We present the case of a young served during examination, the patient may re-
patient with poorly controlled diabetes and Char- main asymptomatic. The most common places
cot neuropathic osteoarthropathy of the right where it may occur, are: the ovaries, the fallopian
foot, which was late hospitalized and raised issues tubes, the bowl and the uterosacral ligaments.
regarding the management of reconstructive sur- The particularities of this case were the atypi-
gery. It is important to emphasize the education cal forms of endometriosis and the lack of symp-
importance of diabetic population presenting to tomatology of the patient.
the doctor as soon as possible because, with the
suitable surgical techniques, appropriate post-
operative care and patient compliance, stability
(169) Unique case, double
can be restored and management can be valu- Salter-Harrys type IV
able for the patient and surgeon. fracture localized at the
distal extremity of the tibia
(167) Atypical endometriosis
and fibula of an 8 year old
findings case report
Erick George Nestianu1,
Bogdan Luchian, Ioan Boleac, Maria Gheorghe Burnei1,2
Luiza Luchian, Manuela Neagu 1
Emergency Hospital for Children Marie S. Curie,
Bucharest, Romania
Objective: Endometriosis is defined as the
presence of endometrial-like tissue (glandular Objective: Salter-Harris fractures are fractures
and stromal) outside the uterus. The abnormal lo- through a growth plate and it is the most common
calisation induces a chronic inflammatory re- fracture that affects the growth plate. These type
sponse which frequently has cyclic manifestations of fracture is described only in children and teen-
like pain, dysmenorrhea, and dyspareunia. It rep- agers in which the growth process hasnt stopped
resents a debilitating condition due to high recur- yet. The deteriorated bone may grow at an ac-
rence rate of the episodes. A quarter of the pa- celerated or decelerated rate witch may result in
tients are asymptomatic. However the most noticeable length discrepancies.
common symptom is abdominal and pelvic pain. They represent 15-35% of child fractures and
The incidence is about 10% percent in the gen- is usually encountered between the ages of 10 to
eral female population. Infertility is one of the 15 years.
most important health problem secondary to en- Method: An 8 year old patient presents him-
dometriosis. self with a Salter-Harris type IV fracture localized

ABSTRACTS
at the distal left tibia and fibula. The fracture oc- ripheral thrombocytopenia. Platelet indices
curred from a falling trauma from a great height. (mean platelet volume - MPV, platelet distribution
The fracture was reduced using a single inci- width and plateletcrit) might reflect these changes
sion. The incision was made along the inter tibio- and are modified prior to the onset of PE.
fibular space and was continued lateral and infe- Objectives: The aim of this study was to eval-
rior of the maleola. The fracture had a dumbbell uate platelet number and platelet indices in preg-
appearance, the two metaphysis and epiphysis nant women with severe early IUGR requiring
fragments being connected by the ventral tibio- delivery for fetal indication before 32 weeks+6
fibular ligament. The posterior tibiofibular liga- days.
ment was situated between the two bone frag- Methods: The study included 27 cases of se-
ments and the inter tibiofibular space. Osteo- vere early IUGR: 19 with associated PE (IUGR+PE)
synthesis aims to anatomicaly reduce the tibial and 8 without superimposed hypertension (IUGR)
fragment through fixing 2 Herbert screws. These followed between 2010 to 2015 in our unit.
screws are epiphyseal placed on the splint with- Complete blood count (CBC) was taken before
out injuring the maturing cartilage. This is done delivery. CBCs from 35 normal matched pregnan-
because injuries could lead to limb inequality cies were used as control (CTRL).
through the shortening of the shin or through ax- Results: Platelet count was significantly re-
ial deviation in valgus or varus. duced in the IUGR groups as compared to con-
Because the fibular bone fragment was too trol: IUGR+PE 229x103/l, IUGR - 216 x103/
small, it could not be stabilized using only Her- l vs CTRL - 293 x103/l (p= 0,009 and p=
bert screws, thus the need of using ephyphisio- 0,02). MPV was increased in severe early IUGR:
centromedular osteosynthesis to assure a correct IUGR+PE 8.9fL, IUGR 8.8 fL and CTRL - 8.09
fixation of the bone fragments and to avoid the fL (p=0,0007 and p=0,03). There was no signifi-
use of a cast. The posterior tibiofibular ligament cant difference in platelet indices between the
was placed in its original place. two IUGR groups.
Results and conclusions: A Salter-Harris type Conclusion: In pregnancies with severe early
IV fracture was reduce by means of a minimum IUGR, platelet indices are modified and this can
invasive procedure in order to achieve an ana- reflect the pathopysiological features underlying
tomical reduction thus avoiding early and late the condition.
complications. The firm fixation of the bone
structures allows early mobilization of the leg with (172) Secondary septic hip
partial weight support in two weeks and full
weight support between 30 and 40 days if the osteoarthritis with no
recover maneuvers begin as soon as the third day. identified primary location
Mobility of the leg is regained in 30 days.
case presentation
(170) Platelet indices in Mihail Eremia, Daniel Constantin
pregnant women with Geamanu, Roman Popescu, Alexandru
Chiribau, Emil George Haritinian
severe early intrauterine
1
Foisor Clinical Hospital of Orthopedics,
growth restriction Traumatology and Osteo-Articular Tuberculosis,
Anca Ciobanu1, S. Colibaba1, Bucharest, Romania
B. Cimpoca1, E. Cocirta1, Gheorghe
Objective: We want to present the difficult
Peltecu2, Anca Panaitescu2 case of a patient with secondary septic hip osteo-
1
Filantropia Clinic Hospital, Bucharest, Romania arthritis and significant associated pathology.
2
University of Medicine and Pharmacy Carol Method: We followed the evolution of a 60
Davila, Bucharest, Romania years old patient who first came to our depart-
ment for pain and marked limitation of hip range
Early intrauterine growth restriction (IUGR) motion with an x-ray exam compatible with the
(with onset before 32 weeks of pregnancy) results diagnosis of advanced osteoarthritis. The lab re-
form uteroplacental insufficiency and shares sults have shown a significant inflammatory syn-
pathological features with pre-eclampsia (PE). In drome. He was sent for further investigations, re-
both PE and IUGR there is endothelial cell dys- vealing a Grawitz tumor for which radical
function, increased platelet activation and pe- nephrectomy was performed. After 4 months the

ABSTRACTS
patient returned to our department accusing se- cancer and thyroid cancer, but is less common
vere hip pain. The lab result have shown a signifi- than the one for lung cancer. Smoking is the main
cant inflammatory syndrome, and the x-ray exam factor in the evolution of this tumour.
revealed an osteolytic supra-acetabular lesion. A Methods: Patient, aged 44, chronic smoker
bone scan and a MRI were performed, but we for 27 years, without past personal pathologies is
couldnt exclude a possible metastasis, so we de- hospitalised for dysphagia, the feeling of foreign
cided to perform a biopsy. The histopathological body in the throat, and for the emerge of a left
result was negative for tumor cells, but the bacte- latero-cervical adenopathy around one month
riological exam (joint liquid aspirated intraopera- ago in order to get diagnosis and specialised treat-
tively through the intact capsule) identified coag- ment. ENT clinical examination correlated with
ulase-negative staphylococci sensitive to all tested other medical investigations show an infected,
antibiotics. The patient was admitted afterward to ulcerous, infiltrated, vegetative tumoral formation
an infectious disease department where they with the starting point at the left pyriform sinus
continued the investigations without being able level, with extension to the left hemilarynx, nasal
to find the primary septic origin and was given septum and a hypertrophy of the inferior nasal
specific antibiotic treatment for 2 months. The level. Subsequently, under general anesthesia and
clinical evolution was complicated by the wors- orotracheal intubation, a biopsy is performed
ening of hip pain and significantly increased in- from the pharyngolaryngeal region and the piece
flammation markers. We decided to perform a is sent to histopathological examination. Due to
resection of the femoral head and took samples the extension of the tumor, the pacient is referred
of tissue and joint fluid for histopathologic and to an oncology specialist for further radio and
bacteriologic exam, but the results were negative. chemotherapy.
We implanted a vancomycin-loaded spacer and Results: The postoperative evolution is fa-
continued intravenous and oral antibiotherapy. vourable under the use of systemic antibiotics,
The evolution was slowly positive with normaliza- anti-inflammatory drugs and pain killers. The pa-
tion of inflammatory markers and at 3 months tient carries out a cervical CT with contrast sub-
postoperatively we performed a cemented total stance from which it can be concluded that pha-
hip replacement. ryngolaryngeal cancer had spread.
Results: At the 6 months follow-up the evolu- Conclusions: The purpose of the treatment is
tion was very good with no residual hip pain, to completely eliminate the tumoral tissue, while
good function, normal biology and no x-ray signs preserving as much of the functions of the larynx.
of loosening. In this case, an under-the-isthmus tracheotomy
Conclusions:In this case we suspected a he- (T4-T5) is performed. The postoperative evolu-
matogenous septic hip arthritis in the context of tion is favorable. Due to the extension of the tu-
neoplastic immunodepression, but we werent mor, the pacient is referred to an oncology spe-
able to locate the primary septic origin. cialist for further radio and chemotherapy.
In case of patients with multiple associated
pathology (neoplastic, infectious, and degenera- (183) Clinical results of the
tive) there are significant diagnostic and thera-
peutic challenges, so the interdisciplinary coop- talus fracture in young
eration is crucial. patients
Andrei Sergiu Hostiuc1, Marinela
(177) Pharyngolaryngeal
Filofteia Hostiuc2, N. Adrian Cursaru1,2,
cancer Alexandru Lupu2, A. Adrian Cursaru1,2
Ruxandra Florentina Ionescu, Robert 1
Mihai Enache, Ioan Alexandru Bulescu Davila, Bucharest, Romania
2
University of Medicine and Pharmacy Carol Emergency University Hospital, Bucharest,
Objectives: Pharyngolaryngeal cancer is a Objectives: A talus fracture appears after ex-

rare type of malignant tumor that develops fre- cessive dorsiflexion movements and requires
quently (5:1) in the male population over the age careful monitoring of the clinical results to pre-
of 60. The occurrence rate of pharyngolaryngeal vent specific complications.
cancer may be compared with the one of oral Methods: A retrospective study that was con-
ducted over a period of three years, from January

ABSTRACTS
2013 to December 2015, in which were includ- the Bagdasar Arseni Emergency Hospital for lipo-
ed patients hospitalized with fractures of the talus thymia (she fell in the bathroom). She accuses
treated surgically in the Department of Orthope- severe abdominal pain, predominant in the left
dics and Traumatology at the Emergency Univer- hypochondrium. Patient is tachycardic, unstable
sity Hospital Bucharest. hemodynamic with skin and pale mucous. From
The study included a total of eighteen patients history: the patient is without known pathological
with fractures of the talus, with the age between personal antecedents. An abdominal ultrasound
18 and 36 years, with an average of 23. From the has been made immediately that showed intra-
total number of patients, eleven patients are male peritoneal liquid, at the level of Morrisons Space
and seven patients are female. Nine patients had and at the bottom of Douglas bag. The liver has
the fracture on the right side, six patients had on increased size, unhomogeneous from the pres-
the left side and the rest had the bilateral fracture. ence of a formation, that replaces the area of the
The average time from the injury until the sur- right hepatic lobe level of approximate 12/10 cm
gery was three days (between one day and eleven with mixt content and unhomogeneous spleene.
days). The mean hospital stay was three days (be- At the CT - thoraco - abdominal exam persiplenic
tween two and fourteen days). Most patients had fluid showed but in medium quantities with
neck fractures (Hawkins III). spleene rupture and an increased size cystic tu-
Results: In Hawkins I type fractures fixation mor formation that occupies the whole right he-
pins were preferred in two cases and in Hawkins patic lobe, suggesting the presence of hydatid
II and III type fractures open reduction and fixa- cyst. Considering her hemodynamic instability,
tion was performed with 2-3 screws in sixteen the posttraumatic hemoperitoneum created by
cases. Subtalar arthrodesis was practiced on a pa- the spleen rupture and the possible hydatid cyst
tient with avascular necrosis. The same proce- rupture the decision is to immediately sent the
dure was used on a patient with Hawkins III type patient to surgery.
neck fracture of the talus that presented aseptic Results: Intraoperative exploration of the ab-
necrosis. Complications occurred after an aver- dominal cavity revealed an enlarged liver, with
age time of nine months (the duration between the cyst in its right lobe, the rupture of the spleen
six and thirteen months). and hemoperitoneum. At the inferior pole of the
Average result of the American Orthopaedic spleen there where multiple blood clots, blood
Foot and Ankle Society (AOFAS) at three months and lacerations. Splenectomy is performed.
postoperative was 91 (between 67 and 96). We decided to postpone the surgical treat-
Conclusion: The talus is an important struc- ment of the hydatid cyst because it was not rup-
ture because of its characteristics: it is 60% cov- tured and the liver was undamaged. We also
ered with cartilage, it is dependent on the main postponed the surgery because de pacient need-
vascular sources and has no muscle inserts. ed a preoperative treatment with Albendazol.
Therefore, these fractures in the talus require Postoperative evolution was favorable.
close attention. Conclusions: The most frequent complica-
tion of a patient with liver hydatid cyst after and
(186) Rare simultaneous abdominal trauma is the rupture of the cyst that
may cause anaphylaxis and sudden death. Even
lesion giant though our patient had a giant liver hydatid cyst,
uncomplicated hydatid the only complication of abdominal trauma was
spleen rupture.
hepatic cyst and ruptured
spleen (187) Pancreatic pseudocyst
Cristina Alina Tatarus - complication of acute
University of Medicine and Pharmacy Carol pancreatitis
Cristina Dumitrescu
Objective: The presentation of a simultane- University of Medicine and Pharmacy Carol
ous lesion composed of an acute illness trau- Davila, Bucharest, Romania
matic ruptured spleen and a chronic condition
right lobe giant hydatid hepatic cyst. Objective: Presentation of a case of a cephal-
Methods: We report the case of a 30 year old ic cyst of the pancreas that occurred after the sur-
woman who presents at the emergency room of gery for acute pancreatitis, treated by an anasto-

ABSTRACTS
mosis between the pseudocyst and the stomach. cal challenge due to the nature of the elderly pa-
Methods: We report a case of a 42 year old tient: multiple comorbidities associated, fractures
woman who was admitted in the General Surgery are often complex and multifragmentary and
Clinic of the Bagdasar Arseni Emergency Hospital bone quality is poor.
with upper abdominal pain. Methods: A retrospective study included ten
The patient presented an episode of severe patients previously treated with total hip prosthe-
acute pancreatitis 3 years ago which required sur- sis in the Department of Orthopedics and Trau-
gical treatment. Then, a Roux-en-Y anastomosis matology at the Emergency University Hospital
between the pancreas and the jejunum was per- Bucharest. The added subjects had Vancouver B2
formed. At this point, physical examination re- and B3 periprosthetic fracture, age of the patients
vealed an epigastric mass in 7 cm diameter, rela- was between 62 and 74, a mean age of 66 years.
tively well demarcated, with semi-solid The surgical treatment was open reduction and
consistency, attached to the deep layers. fixation with Dall-Miles system and in one spe-
Imaging tests (ultrasound, CT, Upper gastroin- cific case surgical revision of the hip. Harris post-
testinal endoscopy) revealed a cephalic pancre- operative hip score was used six weeks after sur-
atic pseudocyst around 76/78/100 mm in size, gery to evaluate the clinical function.
with thick fibrous walls, between the inferior vena Results: The number of operated patients
cava and the origin of the portal vein, compress- was ten and the mean period of hospitalization
ing the right hepatic lobe, the duodenal frame was eight days (with the duration between 7 and
and the regional intestinal loops. The endoscopic 10). Four patients had the fracture on the right
procedure for the cyst drainage failed, so we de- side and six on the left. One patient had a sec-
cided that the best option is to treat it by open ondary loosening of the femoral component and
surgery. required arthroplasty with modular prosthesis.
Results: Considering the size of the cyst and The postoperative management of the patient
the associated symptomatology, the pathology consisted of: at two weeks inspection of the
had absolute indications for surgical treatment, so wound and physiotherapy; at six weeks radio-
it was agreed with the patient to treat it with open graphic examination and mobilization with pro-
surgery consisting in a cystogastrostomy (Jedlicka gressive support on the operated lower limb; at
procedure).The cystic cavity was cleaned and a twelve weeks radiographic examination and if
nasogastric tube was inserted as a precautionary there are signs of consolidation, mobilization with
measure. total support on the operated leg. The average
Postoperative evolution was favorable, with time to union was fourteen weeks. The Harris
parenteral nutrition for 4 days. postoperative hip score was 80.3 after twelve
Conclusions: Despite the modern techniques weeks. No infection of the wound occurred but
of endoscopic drainage of the pancreatic pseudo- two patients experienced delays in consolidation.
cyst, this treatment is not always possible, so the Conclusion: The goal, as it is in the cases of
classic surgery remains the gold standard. hip fractures, is to allow the patient to resume all
activities. However this type of fracture requires
(188) Periprosthetic specialized equipment and training for a good
postoperative recuperation at an increased cost.
fractures in elderly patients
with total hip arthroplasty
Marinela Filofteia Hostiuc1, Adrian A.
Cursaru1,2, Alexandru Lupu1,2, Andrei
Sergiu Hostiuc2, Adrian N. Cursaru1,2,
Catalin Cirstoiu1,2
1
Romania
2
Objectives: Implant-related fractures are be-

coming increasingly frequent as the population
ages and prevalence of prosthetic implants in-
creases. Solving this particular fracture is a surgi-

ABSTRACTS
(189) The importance of Conclusions: Voice restoration using a pho-

natory prosthesis is an important step for social
phonatory rehabilitation and professional reintegration of laryngectomees.
with prosthesis for The prosthesis is inserted in an outpatient proce-
dure and the total cost is covered by healthcare
laryngectomy patients insurance, but for optimum results is necessary
Ion Anghel1, Anca Simioniuc1, Alina patience for patients education concerning the
Georgiana Anghel2, Oana Adriana use and daily maintenance of the device.
Anghel2, Mihnea Cojocarita-Condeescu1,
Rodica Urs1, Mihai Dumitru2 (190) Using blocks of
1
Department of ENT, Coltea Clinical Hospital, tantalum in bone defects of
Bucharest, Romania the cotyloid cavity in the
2
University of Medicine and Pharmacy Carol revision of hip surgery
Adrian Cursaru1,2, Marinela Filoftea
Objectives: Laryngeal carcinoma lately has a Hostiuc2, Alexandru Lupu1,2, Raluca
higher incidence. Unfortunately the greater ma-
Cursaru2, Dan Anghelescu1,2, Razvan
jority of cases are diagnosed in advanced stages
that from a surgical perspective are limited to the Ene1,2, Catalin Cirstoiu1,2
sole option of total laryngectomy. This procedure 1
Emergency University Hospital Bucharest,
implies total removal of vocal cords with loss of Romania
respiratory, phonatory and olfactive functions. 2
Phonatory rehabilitation is a major step for in- Davila, Bucharest, Romania
creasing the quality of life for laryngectomy pa-
tients. Currently there are three procedures: Objective: The aim of the study is to track the
esophageal voice, laryngophone and phonatory clinical and functional outcomes of the patients
prosthesis. However the gold standard is the vo- with hip revisions with massive acetabular bone
cal implantable prosthesis used in the last two de- defects.
cades. The insertion of the device can be primary Method: A retrospective study conducted
during the total laryngectomy or secondary after over a period of 3 years (January 2014-January
the completion of oncology treatment. Coltea 2016) in which were included patients with hip
ENT Clinic has begun performing the insertion of prostheses with massive acetabular bone defects
phonatory prosthesis since 2005. This retrospec- that required replacement with blocks of tanta-
tive study shows our experience performing this lum. In the study, weve included 11 patients (8
procedure. men and 3 women). The average age was 71
Method: This retrospective study gathered a years (between 64 and 78 years). The average
group of 65 patients with laryngeal carcinoma un- time of follow-up was 23 months (between 11
dergoing total laryngectomy at Coltea ENT Clinic and 36 months). For the preoperative evaluation
during January 2014 and March 2016 and bene- of bone defects was used The Radiological Clas-
fited from phonatory rehabilitation through the sification Paprosky. In 9 cases, the bone defect
insertion of Provox prosthesis. was Paprosky type 2B and in 2 cases type 3A. To
Results: Our data show a male predominance determine the outcome of functional results in
among the study group with only one woman un- both pre- and postoperative time we used the
dergoing this procedure. 29 procedures were Harris score.
performed in 2014 and 26 in 2015. All cases ben- Results: 6 patients used prostheses for osteo-
efited from manual HME devices that need man- arthritis secondary to dysplasia, 2 patients for
ual compression of the phonatory device im- aseptic necrosis secondary osteoarthritis and 3
planted secondary to the laryngectomy procedure. patients for primary osteoarthritis.
Concerning the phonatory outcome the data re- The average time elapsed between the pri-
vealed an immediate post procedure phonation mary arthroplasty and the necessitate revision
for one in three patients. Later results are due to surgery was 11 years (between 7 and 16 years).
local massive edema, blood clots and excess se- The post-operative radiological evaluation
cretions jamming the prosthesis or in case of low showed an improvement when it came to the hip
compliance with the use and maintenance of the rotation centre with a vertical average preopera-
devices. tive 3.1 cm (between 1.2 and 4.6 cm) and a post-

ABSTRACTS
operative average position of 1.1 cm (range be- (202) What the nature can
tween 0.5 and 2.3). Average result of preoperative
Harris score were 36 (that range between 11 and do when somebody wants to
56.7) and the postoperative average result were obtain a pregnancy? Case
86 (ranging between 39 and 96). During the reg-
ular check-ups there werent any recorded cases
report and review of the
of early loosening, infection or dislocation of the literature
prosthesis.
Conclusions: The blocks of tantalum used in
Cristina Moisei1, Romina-Marina Sima1,2,
large bone defects in the revision is a good solu- Florina Aldea2 Liana Ples1,2
tion, correcting the centre of rotation and signifi- 1
Bucur Maternity, Bucharest, Romania
cantly improving the functional score. 2
(200) Strategy for an
Objective: Pregnancy is miracle for a family
Addison patient during that wish it so much and a challenge for the ob-
pregnancy stetrician in selected cases. A pregnancy may
have a normal evolution during all the trimesters
Raluca Borina, Ramona Cristescu, of pregnancy and it may have lots of complication
Ediz Huseyinoglu, Gheorghe Peltecu, at term.
Anca Panaitescu Method: We report the case 28 years of age
woman who had a normal pregnancy until 38
Filantropia Hospital, Bucharest, Romania
weeks of pregnancy. She came at the emergency
room for uterine contraction and we had to per-
Addison disease is rare and affects primarily
form cesarian section for obstetrical indication
young women. Association with pregnancy is
(disproportion between the maternal pelvis and
more rarely. We aim to present the case of primi-
fetal dimensions according to clinical and ultra-
gravida with Addison disease diagnosticated fol-
sound evaluation).
lowing an adrenal crisis 2 years ago. With steroid
Results: In our case we performed cesarian
replacement (glucocorticoid and mineralocorti-
section using Joel-Cohen modern technique.
coid therapy) the pacient obtained a pregnancy,
During laparotomy we observed an important ad-
Ecografic scan shows normal development both
hesion process on the pelvis. We performed su-
at first trimester with a low risk for cromosomial
perficial adhesiolisis. We delivered a baby boy of
abnormality, and second trimester. She under-
4200 g and IA 10. We realized the uterine closure
went cesarian section for obstetrical conditions
without any difficulty and we explored the ab-
and a healthy baby weighing 2650 g was deliv-
dominal cavity. We observed that the adhesion
ered at 36th week of gestation. During delivery
process was extended on the right iliac fossa and
she was given intravenous steroids so that she can
the patient had no right adnexa (ovary and fallo-
handle the physical stress. The dosage of electro-
pian tube). Exploring the left adnexa we observed
lytes was necessary before and after delivery.
a very thin fallopian tube, normal left ovary and
Pregnancy outcomes have been proven to be
important vascular adhesions. The question was
unfavorable in many cases of Addison disease.
how did she conceived with such modified anat-
Multidisciplinary care with an endocrinologist,
omy?
obstetrician, maternal-fetal specialist and neona-
Conclusion: The particularity of this case is
tologist is necessary for optimizing the manage-
that a patient with no medical history (surgical in-
ment of Addison disease in pregnancy.
terventions or pelvic inflammatory disease) and
severe modified internal genital organs obtained
a pregnancy in natural way.

ABSTRACTS
(203) The strange pathology Conclusions: IRF is a rare, but challenging

condition, which requires an early diagnosis and
behind a diffuse abdominal a correct medical and surgical treatment. It is very
pain Idiopathic important to be up-to-date regarding this pathol-
ogy, in order to be properly diagnosed it. If it goes
retroperitoneal fibrosis untreated it can cause severe complications, such
Bianca-Ioana Gheorghiu1, S.S. Guler- as end-stage renal failure and death. For this pa-
Margaritis2, Ioanel Sinescu2 thology, long term follow-up is indicated.
1
Davila, Bucharest, Romania (208) Pelvic osteosarcoma
2
Fundeni Clinical Institute, Bucharest, Romania resection and
reconstruction of the
Objectives: Idiopathic retroperitoneal fibrosis
(IRF) is an uncommon disease, characterized by abdominal wall defect with
extensive fibrosis development throughout the pedicled vastus lateralis
retroperitoneum, in the lumbar area, with the en-
trapment and obstruction of retroperitoneal flap case report
structures, such as the aorta, inferior vena cava, Roman Popescu1, Emil George
and ureters, uni or bilateral, often culminating in
Haritinian1, Adrian Ciobanu1,
severe uremia. IRF is generally idiopathic, but can
also be triggered by certain drugs, infections, ma- Dragos Zamfirescu2, Mihail Eremia1,
lignancy and surgery, or secondary to an autoim- Mihai Viorel Popescu1
mune disease. Clinical manifestations are unspe- 1
Foisor Clinical Hospital of Orthopedics,
cific, such as: abdominal discomfort, constipation, Traumatology and Osteo-Articular Tuberculosis,
diffuse lumbar pain. Bucharest, Romania
Methods: We present the case of a 57-year- 2
Zetta Clinic, Bucharest, Romania
old male with diffuse abdominal pain, discomfort
in the left flank, with left hydronephrosis, but nor- Objectives: We present the case of a 17 year-
mal global renal function and a tumor present in old patient, diagnosed with conventional osteo-
the left retroperitoneum, involving the left ureter, sarcoma of the left ala of ilium with pelvic exten-
revealed by the CT scan. Because the initial pa- sion and multiple pulmonary metastases, treated
thology report suggested a low grade non-Hodg- with 9 cures of chemotherapy and 28 sessions of
kin lymphoma, partial removal of the tumor en radiotherapy.
bloc with the left kidney was performed. Immu- Methods: The pelvic MRI highlighted an ex-
nohistochemistry staining later revealed the be- tracompartimental left ilium wing tumor de-
nign fibrous nature of the tissue. Immunosuppres- scribed as heterogeneous and septated, with ne-
sive treatment was conducted for one year, with crosis and T1 hypersignal areas (-calcifications).
good response and regression of the mass. Three- Caudally, the bone involvement extends up to the
year follow-up was normal, afterwards discontin- superior part of the acetabulum, without acetab-
ued. Five years later, he complaint about right ulum cortical or intra-articular extension. Serial
flank pain, abdominal discomfort and mild con- thoracic CT-scans showed multiple, bilateral me-
stipation. Laboratory tests showed uremia and tastases, almost completely calcified, most of
elevation of CRP and fibrinogen levels. The CT them being dimensionally stable. The histopatho-
scan revealed a retroperitoneal mass surrounding logic exam result (after the biopsy performed in a
bilateral common iliac vessels and the ureter, with different department) was conventional osteosar-
obstruction of the kidney. coma. After interdisciplinary consults (-oncology
Results: After the placement of a double J and thoracic surgery) we decided to start with the
ureteral stent, followed by open right ureterolysis resection of the primary tumor and afterwards the
with omental wrapping, the patient regained nor- thoracic surgeon would proceed with successive,
mal kidney function. Pathology report showed bilateral resection of the metastases.
benign fibrous tissue. Immunosuppressive treat- Results: We performed an Enneking type I+II
ment was reinitiated and the double J catheter resection, followed by reconstruction with al-
was removed 6 weeks later. lograft and fixation (2 cables and a reconstruction
Follow-up at 3, 6, 9, 12 and 18 months were plate). The histological exam confirmed the diag-
normal and showed a discrete recession of the nosis of conventional osteosarcoma and tumor-
mass.

ABSTRACTS
free margins. Three days post-op skin necrosis vention, a radiologist for selected cases with
developed on a 9 cm2 area, between the ilio-in- doubtful imagistic findings and an anesthesiolo-
guinal incision and the post biopsy scar. We per- gist as medical specialists. In particular cases,
formed necrectomy and used negative pressure when there are signs of an infection the team
therapy, in association with Vancomycin instilla- should also have an infectionist.; an allergy spe-
tion for two weeks. The evolution was favorable, cialist must help with the management of the pa-
with granulation tissue formation. Two weeks lat- tient when an allergy is the cause of implant re-
er we performed the reconstruction of the skin moval. Last but not least the macroscopic findings
defect with a pedicled vastus lateralis flap. of the tisular reaction must be correlated with the
Conclusions: The excision of the tumor was microscopy, interpretation done by the patholog
complete and it will be followed by the succes- specialist.
sive, bilateral resection of the pulmonary metas- Conclusions: Although implant removal sur-
tases. The evolution was complicated by the skin gery is a routinely done procedure, it has very few
necrosis, (probably determined by the previous clear indications for it. The management of a pa-
radiotherapy and the placement of the biopsy in- tient is complex and is carryed out by an inderdis-
cision). The reconstruction with muscle flap is a ciplinary team, in which every specialist has its
good solution for patients who develop skin ne- role in diagnosing and treating the patients con-
crosis after radiotherapy and major oncologic sur- dition.
gery.
(217) Organ transplant: the
(210) Tissue reaction to mystery of the cellular
orthopaedic implants, intelligence
multidisciplinary approach
Diana Troncota, Alexandra-Teodora
Nicolae Marian Ciurea1, Alexandru Lisias Stuparu, Alexandra Ondu
Dimitriu1,2, Alina Grosu1, Mihail Nagea1, University of Medicine and Pharmacy Carol
Carmen Ardelean2, Olivera Lupescu1,2 Davila, Bucharest, Romania
1
Orthopedic and Traumatology Clinic, Emergency
Clinical Hospital, Bucharest, Romania Objectives: We heard about the changes that
2
University of Medicine and Pharmacy Carol happen in a recipients body as a result of an or-
Davila, Bucharest, Romania gan transplant from a television show, so, we
wanted to come across a scientific explanation for
Objective: Tissular reaction to orthopedic im- those transformations. Moreover, we wanted to
plants has been thoroughly studied, since it can discover which are the similarities in these chang-
be responsible for invalidating pain, as well as for es and also what makes those cases differ from
implant loosening, thus requiring implant remov- one another, things not even doctors or scientists
al (which otherwise, has no specific indications). would expect to happen.
The reaction is enhanced by certain characteris- Methods: We studied Donate Lifes Americas
tics of the host, such as age, comorbidities, as well 2011 statistics and also twenty individual cases
as co-existence of different implants. Yet, there with their characteristics. Three interviews with
are no well-defined clinical protocols and differ- three different recipients explaining how they felt
ent views on the matter are still in discussion. We after the transplant gave us a great insight into un-
propose to evaluate the extent of different back- derstanding how much their lives have changed
round specialists that could be required in pro- and we also learned about their physical and psy-
prely managing, diagnosing and treating a patient chical constantly changing features.
with tisular reaction to orthopaedic implant. Another important source was the research
Method: To describe this topic we analyzed conducted by School of Nursing at the University
14 cases with tissular reaction to implant that un- of Hawaii in Honolulu which studied 10 patients
derwent implant removal in Clinical Emergency (recipients) paralleling with the history of the do-
Hospital, Bucharest, Romania between 2013- nors.
2016. Results: It did not come as a surprise to us
Results: Usually when an implant removal that each patient has gone through some minor
procedure is done, a multidisciplinary team is re- behavioral and physical changes such as: a pa-
quired, including: an orthopaedic surgeon to put tient who received the heart of a young man de-
the surgical indication and to perform the inter- clared that he felt full of energy or another recipi-

ABSTRACTS
ent whose life has substantially improved after therapy for carcinoma of the cervix or congenital
getting a new liver. We were taken aback by some atresia caused by Rokitanski-Kuster-Hauser syn-
cases in which changes were totally unexpected: drome.
there were reported situations in which the re- Results: Vaginal and perineal reconstruction
cipients hair colour had changed, as well as the using acellular biological grafts post- vulvar/vagi-
skin colour. They were strengthened by behav- nal carcinoma or erosion of anterior vaginal wall
ioral ones such as new different taste in music caused by polypropylene meshes was followed
and food. What was even more surprising was a by achieving of a functional vagina approximately
case of a 18 years old woman whose blood type 2 months postoperatively. A relapsing recto-vagi-
has changed and, more than that she acquired nal fistula treated with multiple excisional inter-
the immune system of the donor. ventions was treated successfully, the one year
Conclusion: To conclude with, we would like postoperative follow-up not showing signs of re-
to emphasize the fact that transplants turn out to currence. Creating a neovagina in case of con-
have a great impact on those who undergo such a genital atresia or postsurgery obtained a com-
procedure. It is fascinating how human body pletely epithelialized vaginal wall 2 months
works and how many efforts it must make in or- postoperative, with a vagina of 7-8 centimeters in
der to reestablish its balance. length, functional 4 months postoperatively.
Conclusions: Our personal experience allows
(222) The use of acellular us to affirm that biological acellular third genera-
tion grafts represent an important therapeutic op-
biological grafts in tion in pelvic reconstructive surgery.
gynecologic surgery
Elvira Bratila1,2, Petre Bratila1,3, (241) Chondroblastic
Diana Comandasu1,2, Ciprian osteosarcoma Case report
Coroleuca1,2, Roxana Bohiltea1,4, Panti Zsombor-Alpar
Claudia Mehedintu1,5 Emergency University Hospital, Bucharest,
1
University of Medicine and Pharmacy Carol Romania
2
Department of Obstetrics Gynecology, Chondroblastic osteosarcoma is a high grade
Emergency Hospital Sf. Pantelimon, Bucharest, malignant bone tumor with high fatality rate if un-
Romania treated due to early pulmonary metastases. The
3
Department of Minimally Invasive Surgery, incidence is quite low and it can occur at any age.
Euroclinic Hospital, Bucharest, Romania In the near past, ablative surgery was the only sur-
4
Department of Obstetrics Gynecology, gical treatment option, which in most of the cases
Emergency University Hospital, Bucharest, represented amputation of the affected limb.
Romania Nowadays the keyword in this pathology is limb
5
Department of Obstetrics Gynecology, Clinical salvage surgery, followed by reconstruction sur-
Emergency Hospital Nicolae Malaxa, Bucharest, gery with specific modular prosthesis. The indica-
Romania tion of this kind of surgery unfortunately is limit-
ed, the patient has to be diagnosed as soon as
Objectives: To present our personal experi- possible without having any metastases. A 25 year
ence regarding the use of the latest generation of old male patient presented to our department
acellular biological grafts in various pelvic pathol- with night pain of the left knee, without having
ogies for reconstructive purposes. any injury. Radiological findings were poor, biop-
Method: Acellular biological grafts represent sy of the affected segment showed a chondro-
an optimal alternative treatment in multiple gyne- blastic osteosarcoma. The patient underwent
cological pathologies. From our personal experi- wide resection of the tumor and reconstruction
ence, their use has had favorable results in cases with a modular distal femur and knee prosthesis.
of vulvar or vaginal neoplasia, anterior vaginal Surgery in tumoral pathology is a major chal-
wall erosion caused by synthetic meshes, repeat- lenge, requiring good surgical experience, and it
ed resection of vulvar or vaginal mucosa or re- still has a poor outcome. The main goal is to not
lapsing recto-vaginal fistula. Also their major role harm the quality of daily life and to obtain a fast
in pelvic reconstructive surgery was revealed by rehabilitation and social reintegration. This case
the creation of a neovagina, in cases of vaginal represents and highlights the possibilities of spe-
atresia post radical colpohisterectomy and radio- cific tumor treatment like modular reconstruction

ABSTRACTS
in early stages of chondroblastic osteosarcoma of Surgery consisted in total gastrectomy en-bloc

the femur. with splenic loop colectomy, splenectomy and lo-
coregional lymphadenectomy, followed by rees-
(251) Voluminous tablishing the digestive continuity by Y en Roux
end-to-side eso-jejunostomy and end-to-side
adenocarcinoma of the colo-colic anastomosis. Then a feeding jejunos-
splenic angle of the colon, tomy is performed. Postoperative evolution was
favorable, the patient only developing a properi-
invasive into the greater toneal abscess, that was conservatively treated us-
gastric curvature ing targeted antibiotic therapy and daily wound
dressing.
Adelina Pupaza1, Alida Ciocan1, Andrei
Caragui2, Cristina Gandea2, Mircea
(252) Cholecystic-choledoco-
Gheorghe2, Silviu Constantinoiu2
1
lithiasis: open treatment vs
Clinical Hospital Sf. Maria, Bucharest, Romania
2
University of Medicine and Pharmacy Carol minimally invasive
Davila, Bucharest, Romania treatment comparative
Colorectal cancer is a neoplasia with growing
analysis of costs
frequency both worldwide and in Romania, rep- Mihai Grigoriu1, Radu Costea2,
resenting the third neoplasia among the newly Dana Minca3, Florentina Furtunescu3
diagnosed ones and the first neoplasia of the di-
1
gestive tract. We present a case study of a 64 Discipline Surgery I SUUB; Clinical
years-old female patient who was admitted for Department X General Surgery, Faculty of
abdominal pain localized in the lower left quad- Medicine, University of Medicine and Pharmacy
rant and radiating to the lumbar area, rectal hem- Carol Davila, Bucharest, Romania
2
orrhage, melena, constipation, loss of weight (10 Discipline Surgery II SUUB; Clinical
kg during the last 4 months), nausea and vomit- Department X General Surgery, Faculty of
ing. The patient was previously diagnosed through Medicine, University of Medicine and Pharmacy
a CT scan with a tumor of the splenic angle of the Carol Davila, Bucharest, Romania
3
colon of 75/80 mm diameter, irregular in contour Discipline of Public Health and Management;
and an imprecise demarcation from the great gas- Preclinical Department III Complementary
tric curvature. From her medical history we note: Sciences, Faculty of Medicine, University of
cholecystectomy, a rectocele operation, acciden- Medicine and Pharmacy Carol Davila, Bucharest,
tal laceration of the extensor tendons of the right Romania
hand. Clinical examination : pale skin, dehydra-
tion signs, non-perceptible superficial lymph Objective: Before the laparoscopic era the
node system and an abdominal mass detected mixed gallbladder stones and common bile duct
through palpation in left upper quadrant. Labora- (CBD) stones benefited from open cholecystec-
tory findings: in the normal range, except hemo- tomy and choledocholytotomy, followed up by
globin 5,8 g/dl, fibrinogen 503,4 mg/dl, neutro- external Kehr drainage of the CBD or choledo-
philia (8.95^10 3) leukocytosis, hypoproteinemia cho-duodeno-anasthomosis, the hospitalization
5.6 g/dl. Upper GI tract endoscopy: On the great duration having an average of 14 to 16 days. In
gastric curvature we observe a vegetant and ul- the last decades, the progress of modern technol-
cerated mass. Several biopsies are performed. ogy made the entry in a new era of biliary surgery
Rectosigmoidoscopy: At 40 cm from the anal possible, the era of minimally invasive techniques,
opening we observe a vegetant and ulcerated both laparoscopic and endoscopic, represented
mass which obstruct the colonic lumen. Several by laparoscopic cholecystectomy and interven-
biopsies are performed. Chest X-ray: A small tional endoscopic retrograde cholangiography
quantity of liquid in the left costo-diaphragmatic (ERCP).
recess. Method: This paper is a descriptive type stu-
Preoperative preparation consisted of hema- dy, using a transversal approach focusing on the
tologic and hydroelectrolytic rebalancing, pain- analysis of direct costs for two techniques of mi-
killer management, antisecretory and nutritional xed stones (gallbladder and CBD): open approach
support. versus laparoscopic-endoscopic technique under
a sole general anesthesia.

ABSTRACTS
Results: The cost analysis has shown that the or predictable difficult endoscopic surgery (mul-
open approach is 2.34 times more expensive tiple stones, large stones, tumor pathology, duo-
than the endoscopic approach. The open surgery denal periampullar diverticula). An hour before
approach has proven be more expensive: 62.8% surgery we systematically administered parenter-
for the operatory stage, 23.6% for anaesthesia. ally antibiotic therapy, piperacillin-tazobactam
The biggest cost difference is being displayed in usual, bottle. Fentanyl was used for anesthesic
the post-operatory stage, the classic treatment induction, whenever possible in the in the lowest
uses 300.4% more resources compared to the dose (due to its unwanted spastic effect on the
laparoscopic treatment (the open approach post- Oddi sphincter), etomidate and succinylcholine.
operatory stage is 4 times more expensive than Maintenance of general anesthesia after intuba-
the laparoscopic alternative). tion was provided with sevoflurane and Atracuri-
Conclusion: Having all of this considered, we um. All patients had a good outcome after sur-
must recommend and encourage the usage of the gery, there were no incidents or major accidents
laparoscopic-endoscopic technique in the treat- during general anesthesia or after awakening.
ment of the biliary mixed gallbladder and CBD There were no postoperative complications and
stones. no deaths in this very elderly patients. Adverse
prognostic factors and post-procedural complica-
(253) ERCP under general tions are mainly due to co-morbidities that these
patients may have.
anesthesia method of Conclusions: Age itself does not constitute a
choice in endoscopic contraindication to interventional billiary-pancre-
atic endoscopy, when it is performed under gen-
treatment of biliary eral anesthesia.
pathology in very elderly
patients (267) Reconstruction of the
Mihai Grigoriu1, Iulian Hainarosie2, thumb tip using cross-finger
Danut Vasile1 flap a case series
1
Discipline Surgery I, University Emergency Tiberiu Paul Neagu, Sabina Ionita,
Hospital Bucharest, Clinical Department X Nicoleta Ferariu, Serban Arghir Popescu,
General Surgery, Faculty of Medicine, University
of Medicine and Pharmacy Carol Davila,
Ioan Lascar
Bucharest, Romania Clinical Emergency Hospital, Bucharest, Romania
2
Department of Anesthesiology, Emergency
University Hospital Bucharest, Romania Objective: The thumb is responsible for 50%
of the function of our hand. For this reason, the
Objectives: We present the main aspects of length and function of this finger must be restored
interventional biliary endoscopy under general whenever is possible after traumatic fingertip am-
anesthesia in the very elderly patient (over 80 putation. Using a cross-finger flap in order to
years). cover the defects of the thumb tip is a good surgi-
Methods: We recorded in the 1st Surgical cal option, therefore this paper aims to show the
Clinic of the University Emergency Hospital Bu- short-term clinical results of this procedure in a
charest during 2008-2015 a total of 14 patients number of three cases.
aged over 80 years. Of these, the majority were Method: Three patients with oblique and
men (9) and 5 were women. Jaundice pathology transverse fingertip amputations underwent a
for which we practiced ERCP was represented by two-stage reconstruction procedure in order to
Vater ampuloma -four patients, cephalo-pancre- regain normal function of the thumb. In the first
atic neoplasia - 4 cases and and one common bile stage reconstruction procedure, a cross-finger
duct cholangiocarcinoma. flap was harvested from an adjacent finger on the
Results: The choice of general anesthesia as a dorsal side of the middle phalanx in one case and
form of sedation was imposed by ASA score, proximal and middle phalanx in the other two
which was established by preanesthetic consulta- cases down to the epitenon. A dorsal hinge was
tion. All patients over 80 years had a higher score preserved to ensure vascularisation. The cross-
2 or 3, due to age, general serious condition finger was sutured to the injured finger to provide
caused by the biliary disease (severe jaundice, with neo-pulp tissue. The secondary defect on
cholangitis, impaired liver and kidney function), the dorsal side of the donor finger was covered

ABSTRACTS
using a full-thickness skin graft taken from the births was 1.17% in 2010, 1.51% in 2011 and in
medial aspect of the arm on the same side. A 2013 reached 2.95%. In 61.11% cases the way of
thick dressing and a splint was used for four weeks birth was cesarean section. Over 40% of all pa-
to provide immobilization and shock absorption. tients were admitted with ruptured membranes.
After 21 days the cross finger flap was divided. Conclusions: The incidence of preterm births
The following parameters were evaluated: occur- under 32 weeks of gestation in our clinic has dou-
rence of complications, function recovery, cold bled in the last years, fact that reflects the increas-
discomfort and patient satisfaction (0 to 10 on ing addressability to our tertiary unit. Although
VAS). the most infants were born throw cesarean sec-
Results: The follow-up was three months af- tion, the number of vaginal births tends to rise in
ter the first surgical procedures in all three cases. 2015. The premature rupture of membranes is an
There were no postoperative complication such important cause of preterm births.
as infection, necrosis of the flap, wound dehis-
cence or donor site morbidity. There were no (273) Treatment of
cases of neuroma or neuropathic pain. No pa-
tient reported cold sensitivity. All patient were enchondroma by simple
satisfied with the visual result of the reconstruc- curettage with or without
tion procedure (9 on VAS).
Conclusions: In the amputation of the thumb augmentation: case report
tip, if the bone is intact but there is not enough and literature review
soft tissue to cover it in order to preserve the
length of the finger and restore its usefulness, the F. Popescu, E. Cernat, A.C. Tutovanu,
cross-finger flap is a proper solution in order to S. Tanase, I. Codorean
achieve the recovery of the function and a satisfy- Emergency Military Hospital, Bucharest, Romania
ing visual aspect.
Objective: Enchondromas are benign carti-
(271) Incidence of preterm laginous tumors, often found incidentally and di-
agnosed by the radiographic appearance. En-
deliveries before 32 weeks chondromas/low grade chondrosarcomas are
in a tertiary unit in diagnosed by clinical symptoms and possibly an
Romania aggressive appearance on the radiographs.
The objective of this study is to compare the
Elena Cocirta, Brindusa Cimpoca, outcomes of the surgical treatment with and with-
Simona Colibaba, Anca Panaitescu, out artificial bone augmentation.
Gheorghe Peltecu Methods: The subject case included a patient
with humeral enchondroma treated with simple
Filantropia Hospital, Bucharest, Romania curettage with synthetic bone augmentation
compared to a historical group of patients with
Objective: Prematurity under 32 weeks rep- enchondroma treated with hydroxyapatite recon-
resents only 1% of all births, but involves the most struction who were enrolled as controls. Treat-
important neonatal risks and the highest costs for ment outcomes, including perioperative compli-
medical care. cations (e.g., infection, functional loss, recurrence,
Scope: This study aims to evaluate the inci- postoperative fracture), were surveyed. Differ-
dence of preterm deliveries under 32 weeks in ences in the period needed for bone formation
between 2010 to 2015 in Filantropia Clinical among the patient groups defined by various pre-
Hospital, Bucharest and the obstetrical implica- operative patient conditions were also analyzed.
tions around them. A literature review was performed (ScienceDi-
Methods: We studied the total number of rect, PubMed, NCBI) searching for comparisons
births and the premature births under 32 weeks with the presented case.
which took place in our hospital between 2010- Results: The follow-up period ranged for
2015. We evaluated the incidence of preterm most studies from 6 to 60 months.During the fol-
births, the way of birth and the status of mem- low-up period, no surgery-related complications
branes at admission. occurred. Tumor size categorized by two-dimen-
Results: We had a total of 20.543 births in 6 sional measurements was significantly correlated
years, with 396 (1.92%) preterm birth under 32 with the bone formation period. Polycystic le-
weeks of gestation. The incidence of preterm sions required a prolonged postoperative bone

ABSTRACTS
formation period compared with monocystic le- (289) Squamous cell

sions. The bone formation period did not signifi-
cantly differ between the simple curettage group carcinoma on an old burn
and the historical control group. In most studies scar: diagnosis and
there was no statistically significant differences in
terms of clinical results.
treatment
Conclusion: Enchondromas are usually diag- Cristina Nicoleta Cozma1,
nosed incidentally. Frequently they associate ad- Laura Raducu1, Ruxandra Sinescu2,
jacent pathognomonic soft tissue pathologies,
which are main source of the symptoms. They are
Radu Cristian Jecan1
1
often confused with other malignancies especially Department of Plastic, Aesthetic and
sarcoma, which may be due to the lack of educa- Reconstructive Microsurgery Emergency, Clinical
tion on bone tumors for both the imagist and gen- Hospital Prof. Dr. Agrippa Ionescu, Bucharest,
eral orthopedists surgeon. Curettage with aug- Romania
2
mentation proved to be a safe, promising modality Department of Plastic, Aesthetic and
for the treatment of small enchondromas of the Reconstructive Microsurgery Emergency, Clinical
upper limb, hand and foot. Hospital Elias, Bucharest, Romania
(279) Hysteroscopic Objective: Cutaneous squamous cell carci-

noma is a malign tumor of the skin, which usually
myomectomy: our technique evolves from precursor lesions, with an invasive
and perioperative character and metastatic potential. In rare cases
(2%), scuamous cell carcinoma can arise on
assessment chronic wounds or old scars, having a more ag-
Gica Nicolae gressive pattern. The purpose of this paper is to
present the diagnosis and therapeutic manage-
Filantropia Obstetrics and Gynecology Hospital, ment of a scuamous cell carcinoma developed on
Bucharest, Romania an old burn scar.
Methods: We report the case of a 60 year old
Hysteroscopic myomectomy represents the patient who was admitted in the Plastic Surgery
gold standard treatment for submucous myo- Department with a tumor on the dorsal part of
ma. We conducted a retrospective analysis from the proximal interphalangeal joint of the right
September 2014 to March 2016. We reported a third finger, developed over an old burn scar. The
series of 35 cases with submucos myomas, de- tumor had an ulceroproliferative growth, indura-
tected by transvaginal ultrasonography in symp- tion of the base, friable consistency and was
tomatic patients: infertility and abnormal uterine bleeding. No regional lymphadenopathy was
bleeding (menorrhagia, metrorrhagia and meno- present. To establish the proper treatment finger
metrorrhagia). We performed an hysteroscopic radiography and tumor biopsy was performed.
bipolar resection of all myomas. This procedure Results: The radiography revealed no inva-
has the advantages of reducing myometrial trau- sion of the phalangeal bones. The result of the
ma and decreasing postoperative risks of adhe- histopatological examination was scuamous cell
sion formation. Our data suggests that hystero- carcinoma and surgical amputation of the finger
scopic myomectomy is a safe and effective was decided. No local complications were en-
surgical treatment. All patients had a short hospi- countered, the patient was referred to an oncol-
talization. No serious complications occurred. ogy center and adjuvant treatment was started
The techniques depends on the intramural exten- over.
sion of the myoma, as well as on personal experi- Conclusions: Scuamous cell carcinoma de-
ence and available equipment. veloped on a burn scar is called Marjolin ulcer
and is considered a highly aggressive tumor with
a rapid rate of regional metastases, being neces-
sary a resection margin of 2 cm or more. Amputa-
tion is not a rule, but in our case was necessary
because otherwise we could not achieve ade-
quate margins.

ABSTRACTS
(291) Importance of (292) Invasive basal cell

rectoragy in sigmoidian carcinoma of the lower
adenocarcinoma eyelid in a patient with
Mirela Emanuela Stanciu, Bogdan Mihai pulmonary tuberculosis
Ursut Cristina Nicoleta Cozma, Laura Raducu,
University of Medicine and Pharmacy Carol Ruxandra Sinescu, Radu Cristian Jecan
Davila, Bucharest, Romania Department of Plastic, Aesthetic and
Reconstructive Microsurgery Emergency, Clinical
Usually, people consider that clinical testing is Hospital Prof. Dr. Agrippa Ionescu, Bucharest,
unnecessary and just time consuming. But if they Romania
have the slightest pain or other symptoms, in the
best case scenario, they come running to the hos- Objective: The main cause of eyelid and can-
pital. And thats a good thing because it allows thus defects are skin tumours, basocellular carci-
detection of pathologies in relatively early stages. nomas being diagnosed in 90% of the cases. Full-
That was the case of a 64-year-old patient that thickness lower eyelid defects may lead to
presented in the clinic, disturbed by rectoragy exposure keratopathy, corneal ulceration, and
and abdominal pain. even blindness, total reconstruction of the lower
The clinical exam showed a mild pain in the eyelid being considered an essential and also
abdomen and right iliac fossa. The rectal exam challenging procedure.
did not show anything abnormal. He is proposed Methods: We describe the case of a 48 year
for a colonoscopy. During this procedure, we dis- old patient admitted in the Plastic Surgery De-
covered a tumoral formation, ulcero-hemorrhag- partment with a tumour involving the lower eye-
ic, 25 cm above the anal orifice(AO). lid, the medial canthus and a quarter of the upper
CT scan showed a circumferential thickening lid. After additional medical tests the patient was
of the sigmoidian wall at approximately 20 cm suspected with pulmonary tuberculosis which
above AO, with a slight perisigmoidal fat infiltra- was diagnosed and treated in a Pneumoftiziology
tion and enlarged perilesional lymph nodes. Dur- Institute. After 5 months, he returned in our de-
ing the digestive endoscopy, a biopsy was taken partment, the skin tumour was excised and the
from the lesion.2 weeks after the endoscopy, the lower eyelid was reconstructed using a cartilage
histopathological diagnosis was sigmoidian ade- graft from nasal septum which was covered with
nocarcinoma and the patient was proposed for a cheek rotation flap.
surgery. Results: The result of the histhopatological
The patient decided in the next days to un- examination was basocellular carcinoma comple-
der-go surgery and it was performed a Dixon low tely resected, with safety margins.
anterior resection, with latero-terminal colorecto- Clinical examinations revealed no complica-
anastomosis. tion in day 10 after removing the sutures. After 2
The postoperative evolution was so good that months, there was no evidence of recurrence.
the patient was discharged in day 6 with intestinal Conclusions: The main rule in tumour sur-
transit present for feces and gas and is currently gery of the eyelids is to assure radical excision in
cancer free. order to prevent recurrences. Despite the size
The importance of this case is that it attests the and the invasion of the tumour on the lower eye-
good prognosis in the evolution of the disease of lid, medial canthus and upper eyelid, complete
patients with early-bleeding malignant tumor for- resection was possible with an adequate recon-
mation. struction, the postoperative scars being function-
ally and also cosmetically acceptable.

ABSTRACTS
(294) Parasitic twin because the parents decide not to terminate the
pregnancy, complete excision of the vestigial twin
syndrome: case report is curative and it permits the exact confirmation
Octavian Munteanu1, Alexandra of the diagnosis.
Munteanu2, Luiza Radulescu1, Monica
Cirstoiu1, Diana Neculcea3, Florina (295) Interdisciplinary
Badea3, Calina Savu3 approach in a rare disease
1
Department of Obstetrics and Gynecology, Launois-Bensaude
Emergency University Hospital, Bucharest, adenolipomatosis
Romania
2
Emergency Hospital for Children Marie S. Curie, Alexandru-Rares Stoian1,2, Irina-
Bucharest, Romania Alexandra Calangea1,3, Ionut Simion
3
University of Medicine and Pharmacy Carol Coman2, Elena-Violeta Radu2, Oana
Ilona David2, Valentin Titus Grigorean1,2
1
Obectives: Heteropagus or parasitic twins University of Medicine and Pharmacy Carol
are asymmetric conjoined twins in which the tis- Davila Bucharest
2
sues of a severely defective twin (parasite) are de- Department of General Surgery, Clinical
pendent on the cardiovascular system of the oth- Emergency Hospital Bagdasar-Arseni, Bucharest,
er, largely intact twin (autosite) for survival. Para- Romania
3
sitic twins occur when a monozygotic twin em- Department of Cardiology, Clinical Emergency
bryo begins developing in utero, but the pair does Hospital Bagdasar-Arseni, Bucharest, Romania
not fully separate, and one embryo maintains
dominant development at the expense of the Objectives: We propose in this paper to ana-
other. The aim of this report is to present a case of lyze the valences of the interdisciplinary approach
asymmetric conjoined twins. in a rare disease Launois-Bensaude adenolipo-
Methods: We report the case of a 35 year old matosis (Madelung disease, Brodie syndrome).
pregnant woman without any prenatal care, who Along with colleagues in other specialties we
gave birth by a caesarean section to a female in- have developed a treatment plan that virtually
fant in her 37th week of gestation. The neonate dictated the operatory moment, the tactics ad-
presented on his right lateral side a parasitic lum- opted and the postoperative follow-up plan.
bosacral vertebral column, a pelvis and both infe- Methods: We bring to your attention a 65
rior limbs. The appropriate diagnosis in this case years old patient, without significant surgical his-
is parasitic twin syndrome. tory for the current episode, which shows multi-
Results: The only option for the autosite to ple symmetric lipomatosis especially in the cervi-
survive and to have a normal life is to surgically cal area, accentuated in the last 2 years, fatty liver
remove the vestigial twin. In the majority of the disease, hypercholesterolemia, stages II-III hyper-
cases, the procedure is done immediately after tension insufficient controlled by medication.
birth, especially if the infant has a life-threatening Results: Ln terms of postoperative outcome,
situation. If the child is stable and early surgery is the results are at least comparable with those in
not indicated, the procedure is usually delayed the literature, but with a better control of cardio-
until the infant reaches the age of 6 to 12 months. vascular risk factors and an obvious benefit in
In this case, the neonate is larger and more ca- terms of postoperative scars. This is probably due
pable of tolerating better the surgical procedure. to both the adopted therapeutic plan and the
Separation in asymmetrical twins has a 92% sur- follow-up of the patient.
vival rate. In the reported case the surgical inter- Conclusions: The inter/multidisciplinary ap-
vention is scheduled to be done at the age of 12 proach especially for rare diseases brings short-
months. terms benefits and especially medium and long
Conclusion: The estimated incidence of para- term benefits by contribution of each specialty,
sitic twin syndrome is approximately 1 per 1 mil- follow-up of the patient made by the entire team
lion live births. Due to ultrasonography, the diag- and by modifying the therapeutic attitude when-
nosis of this syndrome is made early and the ever necessary.
parents have the opportunity to evaluate their
options. If the malformation goes undiagnosed
either because of the absence of prenatal care or

ABSTRACTS
(297) Diagnosis and infiltration of the pelvic wall may be implicated as

a potential etiology and an indication for laparos-
treatment of endometriosis copy must be discussed for both diagnosis and
involving the sacral plexus treatment. Laparoscopic resection of the endo-
metrial tissue, especially of cystic and nodular le-
Oana Ilona David, Violeta Elena Radu, sions, combined with presacral neurectomy is
Ionut Simion Coman, Vlad Andrei proven to be effective in treating pelvic pain.
Porojan, Valentin Titus Grigorean
Department of General Surgery, Clinical (302) Proper selection of
Emergency Hospital Bagdasar-Arseni, Bucharest, patients with sural
Romania
neurocutaneous flap in
Objective: Endometriosis involving the sacral presence of peripheral
nerve roots is a rare pathology, often poorly un- arterial disease: a study of
derstood and neglected. The clinical signs sug-
gesting intrapelvic nerve involvement include digital subtraction
perineal or sacral pain or pain irradiating to the angiography performed in
lower limbs, lower urinary tract symptoms, tenes-
mus or dyschezia, gluteal pain (often misinter- 47 cases
preted as lombosciatalgia). Up to 24% of pelvic Cristian Radu Jecan1, Daniel Hernic2,
pain is subsequent to endometriosis. Laparoscop-
Crisstina Cozma2, Adriana Catalina
ic approach of the plexus sacralis in endometri-
otic infiltration of the pelvis is a feasible proce- Neagu2, Laura Raducu1
dure for trained laparoscopic surgeons who have 1
a good knowledge of the retroperitoneal pelvic Davila, Bucharest, Romania
neuroanatomy 2
Emergency Clinical Hospital Prof. Dr. Agrippa
Methods: We present the case of a 35 years Ionescu, Bucharest, Romania
old patient presented with sacral pain radiating
down the anterior aspect of the left leg into her Objective: Sural flap has now become a
foot; the pain first appeared 5 months prior to mainstay for reconstruction in the distal leg. Risk
presentation and was accentuated in the upright factors, particularly arteriopathy, can influence re-
position. Clinical examination showed no signifi- sults. Secondary arterial supply had been pro-
cant deficits of the inferior limbs, normal reflexes, posed.
hypoesthesia in the territory of innervation by the Methods: Results from digital subtraction an-
S1, especially on the left side. MRI examination giography of the lower limb in 47 patients were
showed a cystic sacrum tumor at S2-S3 level, of analyzed, regarding the patency of perimaleollar
approximately 3 cm in diameter, migrated toward septocutaneous perforators, calcaneal and lateral
the pelvis in the left obturator space. Clinical ex- tarsal artery. Analysis of angiography was per-
amination, laboratory investigations and imagistic formed with OsiriX Imaging Software for MacOS,
findings led to the diagnosis of cystic sacrum tu- viewing vessels greater than 0,1 cm diameter.
mor. Comparison with Doppler echography in a simi-
Results: The patient suffered a surgical inter- lar group of patients was performed.
vention. A laparoscopic approach was chosen. Results: Patients had a mean age of 52, with
Multiple hemorrhagic areas suggestive for endo- male gender dominance (n=37). Patency of peri-
metriosis were found on the urinary bladder. Dis- malleolar septocutaneous perforators was con-
section revealed a cystic tumor of approximative- firmed in 24 cases (51 percent), of the calcaneal
ly 3/3cm on the lateral left margin of the sacrum. artery in 15 cases (32 percent) and of lateral tarsal
The tumor was resected and laparoscopic neu- artery in 13 cases (27 percent) - fig. 1. The last
rolysis of the sacral plexus was performed. The two were both observed in 10 cases (21 percent).
patient has a favorable postoperative outcome, Patency of all three sources were observed in
with remission of pain and hipoestesia. Patient eight cases (17 percent) - fig. 2. Angiography
was discharged with no sacral pain; she showed could offer similar results with better visualization
no paresthesia or signs of sphincter defects. of arterial network distribution in comparison
Conclusions: In young patients, with chronic with standard Doppler echography (p<0,05),
lombosciatalgia, where no neurological/orthope- evaluated in an equivalent group of patients
dic etiologies have been found, endometriotic (n=28).

ABSTRACTS
Conclusion: Our study confirms the likeli- and early second trimesters, because is less bleed-
hood confirmation of arterial sources and could ing and no risk to induce a miscarriage. LCC is
minimize necrotic complications of the sural flap, minimally invasive, extremely safe and should
in patients with arteriopathy. A backup arterial replace the traditional laparotomy technique.
network was observed, related to a collateral vas-
cular network development. Preoperative digital (313) Ten years-experience
subtraction angiography evaluation of patients
with defects located in lower leg, heel and foot analysis with the distally
could minimize complications. The vascular anat- based sural flap: results,
omy of sural flap in such patients appears differ-
ent from that found in normal subjects. complications and
The protocol was approved by the ethics com- optimization of results
mittee of the University Emergency Hospital Prof.
Dr. Agrippa Ionescu. Daniel Hernic1, Laura Raducu2, Ovidiu
Stefanescu1, Cristian Radu Jecan2
(312) Treatment and 1
Emergency Clinical Hospital Prof. Dr. Agrippa
Ionescu, Bucharest, Romania
management of cervical 2
incompetence in pregnancy Davila, Bucharest, Romania
after conization
Objectives: Wound closure in the distal lower
Adina Lungu, Antoaneta Punga, extremity, has always been a difficult problem.
Elvira Bratila, Monica Cirstoiu Debridement must be followed by coverage with
well vascularized tissues. Treatment options are
University of Medicine and Pharmacy Carol difficult by a lack of available mobil skin, frequent
Davila, Bucharest, Romania poor surrounding vascularity, weight bearing re-
quirements, frequency of external fixation devic-
Objective: Cervical incompetence occurs in es and comorbidities. Since its introduction the
0.5-1% of all pregnancies, sometimes resulting in distally based sural flap has evolved through a va-
significant pregnancy lost. Laparoscopic cervi- riety of technical modifications and has now be-
coisthmic cerclage is less invasive, has fewer com- come the authors mainstay for reconstruction of
plications and should replace the traditional lapa- the distal leg, heel and foot. We will describe our
rotomy technique. experience with the distally based sural flap and
Methods: We present the case of a pregnant, the variety of anatomical configurations used.
aged 28, at first pregnancy with a history of con- Methods: We performed 34 sural flaps over a
ization for HSIL at Pap test with the result CIN III. 10 year period. Mean patient age was 49.2 yrs.
At her first visit to our hospital she was 10 weeks. Causes of defects included trauma, osteomyelitis,
Vaginal examination revealed an exceedingly arterial and venous insufficiency, unstable scars
short cervix that was flush with the lateral vaginal and cancer resection. The wounds included skin,
fornix. Counselling regarding the risks and bene- fascia, tendon and skeletal structures. Nine pa-
fits of the procedure performed either laparo- tients had comorbidities. Additionally, 4 had an
scopically or via laparotomy were provided. A external fixation device in place. Of these flaps,
laparoscopic cervicoisthmic cerclage (LCC) was 24 were fasciocutaneous, 8 musculocutaneous
inserted at 12 weeks of gestation. The procedure and 2 were fascia only. Two flaps were delayed.
was uncomplicated and she was discharged from The final criteria for success were a healed
hospital one day after laparoscopy. wound, normal unassisted ambulation, with a 12
Results: A caesarian section was planned for month follow up.
38 weeks of gestation but the patient went into Results: Success was achieved in 31 of the 34
labor at 36 weeks. At caesarian section there was patients. There were 9 early complications - 2 of
a scar tissue covering the cerclage knot. A trans- which were major, leading eventually to amputa-
verse lower segment incision was employed to tion and 7 minor complications, all of which re-
deliver a male infant with Apgar scores 9. solved with wound care. Additionally, there were
The cervicoisthmic cerclage was left in situ. 2 late complications, one major leading to ampu-
Conclusions: The case shows that laparosco- tation. Flap surface dimensions ranged from 35 to
py reduce postoperative pain, adhesions and hos- 240 cm sq.
pital stay and provides faster recovery than lapa- Discussion: We found a statistically signifi-
rotomy. LCC may be performed during the first cant correlation between complications and vas-

ABSTRACTS
cular comorbidities (p=0.03) also with patient other metastases beyond 2 cm in the right lobe.
advanced age (p=0.008), consistent with other In February 2016 she underwent a maximal cyto-
studies (2). We have not found significant differ- reduction of the left lobe with widening the deb-
ences in outcome between free flaps and sural ulking on segments I, V, and VIII of the right he-
flaps for similar wounds up to 240cm sq in size patic lobe as well as lymphadenectomy and the
(p=0.02). We did not need to remove external resection of the bile duct. There were no postop-
fixation devices. erative complications. The treatment was decid-
Conclusions: Sural flaps were successfully ed according to the histopathological and imuno-
used for a variety of distal leg, heel and foot histochimic exams.
wounds. In our experience, there is no difference Conclusions: The aggressive treatment for
in outcome between free flaps and sural flaps for this patient with GIST stage IV is justified by trying
equivalent wounds. Outcome can be enhanced to obtain at least 5 year survival from diagnostic.
by flap delay, microsurgical venous outflow aug-
mentation, or intermittent venous drainage. (317) Common bile duct
stones a comparison
(316) A clinical case of
between different surgical
gastrointestinal stromal
approaches
tumor stage IV diagnostic,
therapeutic and monitoring Adelina-Mihaela Sorescu,
Bogdan Diaconescu
challenges
Ioana Ruxandra Calapod1, Matei Davila, Bucharest, Romania
Mandea1, Maria Tronaru1, Florin Botea2,
Mirela-Patricia Sirbu-Boeti2, Objectives: Common bile duct stones (CBDS)
Irinel Popescu2 can be categorized into primary (calculi formed
inside the CBD) or secondary (originating from
1
University of Medicine and Pharmacy Carol the cholecyst). Being able to differentiate the two
Davila, Bucharest, Romania of them is a key aspect when dealing with CBDS,
2
Center of General Surgery and Liver as this, aside from the usual parameters (risk, ef-
Transplantation Dan Setlacec, Fundeni Clinical fectiveness, etc.) will decide which type of treat-
Institute, Bucharest, Romania ment should be applied. Even if the clinical man-
ifestations are common for the two conditions
Background: Gastrointestinal stromal tumors (biliary colic, nausea, vomiting and others), the
are the most common mesenchymal malignan- laboratory tests and the imagining findings are
cies of the digestive tract and are considered to able to determine the cause of CBDS.
originate from neoplastic transformation of either We will examine and compare the three main
the intestinal pacemaker cells of Cajal or the pre- surgical approaches: endoscopic retrograde chol-
cursor pluripotential stem cells. angio-pancreatography (ERCP) with endoscopic
Methods: A 32-year-old female patient had a biliary sphincterotomy (EST), laparoscopic and
surgery in 2010 for gastrointestinal stromal tumor open surgical bile duct clearance.
of the ileum, Krukenberg tumor of the right ovary Methods: We examined a number of patients
and peritoneal disseminations in the pouch of from the Floreasca Emergency Clinical Hospital,
Douglas and in the round ligament of uterus. comparing the outcomes following different sur-
Results: She underwent a segmentary enter- gical therapies for CBDS. Apart from this, we
ectomy with termino-terminal anastomosis, a re- compared our results with the findings from pre-
section of the metastatic tumor of the ovary and vious studies.
of the peritoneal metastases. After the surgery, Results: Due to the success rate varying be-
adjuvant chemotherapy treatment with tyrosine tween 85% and 95%, the low mortality rate and
kinase inhibitors was initiated: Nilotinib (March- the less serious post-operation complications, the
May 2011), Imatinib (June 2011-March 2014), laparoscopic procedure still remains the elected
Sunitinib (April 2014-October 2015). However,in surgical intervention. Having in mind factors such
2015 she presented with multiple bilateral he- as the number and size of the calculi, the diame-
patic tumors and with hilar adenopathy. 3D im- ter of the cystic and common bile ducts and the
age reconstruction of the liver revealed the loca- presence of intrahepatic stones, surgeons can ei-
tion of the most massive tumor as well as multiple ther use a trans-cystic or a trans-ductal approach.

ABSTRACTS
When speaking about the ERCP/EST, the main The patient was operated within 48 hours of
inconvenience is considered the requirement of arrival. With a tourniquet applied, the tendon
multiple interventions (in about 25% of the cas- was exposed through a midline longitudinal inci-
es). However in the last decade, an impressive sion extending from the upper patellar pole to the
alternative of the technique has been developed, tibial tuberosity. Rupture of the tendon in the
namely the endoscopic balloon dilation of the pa- middle part was observed which is an unusual lo-
pilla. calization, probably due to the corticosteroid in-
As a last resort an open surgical procedure can filtration that affected the collagen fibers in the
be used. Even though it has many disadvantages, patellar tendon.
it is also more successful than the other methods. The free tendon edges were cleaned of re-
Conclusion: Nowadays, CBDS benefits from maining soft tissue and prepared with whipstitch
a wide range of possible surgical. Choosing one sutures. The sutures were made to set the height
treatment or another can be a very difficult and of the patella, using the previously calculated In-
complex task. The surgeon must rely on the risk sallSalvati ratio of the uninjured knee.
factors, the possibility of difficult laparoscopic or At six-month he was able to walk unaided
ERCP/EST procedures and of course on their clin- with full active knee extension and 130 of flex-
ical judgement, when deciding which interven- ion, achieving pre-injury functional levels.
tion has the best outcome. The rupture of the patellar tendon in the mid-
dle part is a rare occurrence and the exact inci-
(319) Repair of an dence remains unknown.
This case confirms what studies postulate that
uncommon patellar tendon the incidence of patellar tendon rupture rises in
rupture correlated with the case of a chronic suffering or local corticoste-
patellar tendinitis and the roid therapy.
A proper diagnosis and the correct early treat-
injection of local ment favors for total recovery of the patient.
corticosteroid
Georgian Iacobescu1, Dan Anghelescu1, (321) Synchronous rectal
Adrian Cursaru1, Alexandru Lupu1,2, and gastric
Tudor George1, Razvan Ene1,2, Catalin adenocarcinomas. Case
Cirstoiu1,2 presentation
1
Emergency University Hospital, Bucharest, Florina-Raluca Badea1, George Pariza2,
Romania
2
University of Medicine and Pharmacy Carol Carmen Mavrodin2, Marian Simion2,
Davila, Bucharest, Romania Erika Adam2
1
The patellar tendon ruptures are quite rare. Davila, Bucharest, Romania
However, the complications of an untreated rup- 2
Department of General Surgery, Emergency
ture of the extensor mechanism can be extremely University Hospital, Bucharest, Romania
disabling. Surgical intervention allows an excel-
lent recovery of motion and strength. The focus of Objectives: The development of synchronous
this case presentation is acute patellar tendon colon and stomach cancer is particularly rare, ac-
rupture at a person that was discovered to suffer counting 3 to 5% of gastric cancer patients. The
of a patellar tendinitis treated with local infiltra- incidence of multiple primary adenocarcinomas
tion of corticosteroid substance. in most of the studies was under 4.3% of gastroin-
A fit and well, 30-year-old male presented in testinal tumors. The aim of this presentation is to
the emergency room with pain and functional review the management of patients with synchro-
impotence at the right knee after an accident in a nous lesions, and to draw conclusions regarding
recreational sport (football). There were made a their optimal diagnosis, treatment and evolution.
clinical and Rx exam and the diagnosis of patellar Methods: We report the case of a 67 year-old
tendon rupture was established. An eco exam patient who presented lower gastrointestinal
was also made after admission. bleeding, transit disorders (constipation) and
Anamnesis revealed a 5 year old patellar ten- weight loss. Colonoscopy revealed a bleeding
dinitis that was treated with local infiltrations of a rectal mass of 6-7 centimeters, at 12-13 centime-
corticosteroid substance (BETAMETHASONUM).

ABSTRACTS
ters distance from the anus. An abdomino-pelvic treatment, then there must be a well-established
computed tomography was performed and no balance in the beneficial anticoagulant dose for
other pathological changes were identified in the the cardiac pathology and the non-beneficial
gastrointestinal tract. An anterior protectomy with dose for other pathologies.
end-to-end colorectal mechanic anastomosis was Methods: we present the case of a 71 years
decided in view of the diagnosis of rectal cancer. old female patient known with aortic mechanical
During the operation, inspection of the abdomi- prosthesis mounted for severe rheumatic aortic
nal cavity incidentally revealed the presence of insufficiency that had a treatment with acenocou-
gastric cancer and a liver tumor of 2/2 centime- marol (Sintrom) at home, admitted to the Cardi-
ters with a hemangioma aspect, on the underside ology Department of Bagdasar-Arseni Clinical
of the left hepatic lobe. Subtotal gastrectomy with Emergency Hospital, where she was given instead
Billroth II end-to-side gastrojejunostomy and an unfractionated heparin. Subsequently, the patient
Omega loop and Braun entero-enterostomy were developed an episode of upper gastrointestinal
performed. bleeding with melena, haemoglobin levels reach-
Results: Histopathological examination re- ing 3,54 g/dl. The occurrence of the gastrointesti-
vealed a moderately differentiated gastric adeno- nal bleeding required the emergency stop of the
carcinoma (pT3N2) and a well differentiated rec- anticoagulation treatment and the carrying of a
tal adenocarcinoma (pT2N0), both with lymph superior digestive endoscopy. The endoscopy re-
nodes metastases, and a hepatic hemangioma. vealed an antral protrusive, prolonged tumour,
Nine months after the surgery, there is no evi- with multiple ulcerations on its surface, but no
dence of recurring disease. active bleeding was identified. The patient was
Conclusion: The synchronous carcinomas de- afterwards transferred into the General Surgery
tected in a gastric cancer patient are most fre- Department for the surgical procedure. The per-
quently located in the colon and rectum, fol- formed abdominal ultrasonography highlighted
lowed by the lung, esophagus and liver. Consi- disseminated metastases in both the hepatic
dering that the incidence of synchronous cancers lobes.
is increasing, the present study cautions the ne- Results: after a minimal hematologic rebal-
cessity for a detailed and accurate preoperative ance, we performed a hemigastrectomy with a
staging, imagistic investigations and intraopera- Reichel-Polya type gastro-jejunum anastomosis.
tive examination to identify multiple primary tu- Given the macroscopic appearance of the liver
mors, in order to ensure an appropriate care, and the poor cardiac state of the patient, the sur-
management and surgical intervention for these gical procedure was limited to a palliative one,
patients. the main goal being the haemostasis in the diges-
tive tract and the possibility of resuming as quick
(323) Limits of as possible the anticoagulant treatment. Postop-
eratively the patient resumed the treatment with
anticoagulation therapy in unfractionated heparin. Surgical the patient had
patients with bleeding favourable outcome, with the suppression in the
eight day of the nasogastric tube and the progres-
gastric neoplasms that sive resumption of the nutrition, also with pro-
associate metalic valvular gressive correction of hemodynamic parameters.
prostheses The patient was discharged 12 days after the sur-
gery with treatment with Sintrom at home.
Ionut Simion Coman1, Vlad Andrei Conclusions: correct dose of anticoagulant
Porojan1, Oana Ilona David1, Elena- varies with each patient and disease. The associa-
tion with another lesion that contraindicates the
Violeta Radu1, Valentin Titus Grigorean1,2
anticoagulant treatment predisposes the doctors
1
Department of General Surgery, Clinical to both a surgical and cardiological therapeutic
Emergency Hospital Bagdasar-Arseni, Bucharest, challenge.
Romania
2
Objectives: anticoagulant treatment is indis-

pensable for the patients that have metallic heart
valves prostheses. If the patient associates anoth-
er lesion that contraindicates the anticoagulant

ABSTRACTS
(324) Sino-nasal fibrous (328) Giant retroperitoneal

dysplasia: management and liposarcoma case report
therapy challenges Violeta Elena Radu, Oana Ilona David,
1
Catalina Pietrosanu , Viorel Zainea , 2 Ionut Simion Coman, Vlad Andrei
Mura Hainarosie1, Irina Gabriela Ionita1, Porojan1 Valentin Titus Grigorean
Octavian Ceachir2, Razvan Hainarosie2 Department of General Surgery, Emergency
1
University of Medicine and Pharmacy Carol Hospital Bagdasar-Arseni, Bucharest, Romania
2
Institute of Phonoaudiology and Functional ENT Objective: This is a rare case of giant liposar-
Surgery Prof. Dr. Dorin Hociota, Bucharest, coma developed in the mesentery root in an old
Romania female patient, with no suggestive symptoms of
retroperitoneal invasiveness.
Objectives: Although a benign disease in na- Methods: We present the case of an 83 years
ture, fibrous dysplasia can cause serious issues old patient, with no significant medical history,
due to the replacement of normal bone and mar- presented in Bagdasar Arseni Emergency Hospi-
row with woven bone and fibrotic tissue. The distal, General Surgery Clinic as a non-emergency,
ease is rarely located at the level of the paranasal with a large abdominal tumor of approximately
sinuses, but when this situation occurs, it can 20/20 cm. The abdominal mass was firm, non-
raise important problems regarding the best ther- adherent on the anterior abdominal wall, fixed
apeutical options. on the posterior abdominal wall, with pain re-
Method: The correct management of a pa- sponse on palpation. Abdominal ultrasonography
tient with fibrous dysplasia implies a complete showed a 20/25 cm tumor situated in the inferior
evaluation performed by a multidisciplinary team. abdominal cavity with mixt content solid and
Although the final diagnosis requires a histopath- liquid without being able to establish an organ
ological examination, complete imagistic investi- appartenance. CT scan of the abdominal cavity
gations are mandatory. The surgeon must always was not possible due to technical difficulties. Bio-
have in mind the fact that the most important key logical samples showed anemia.
factor in the correct management of these pa- Results: Surgical intervention was performed.
tients is choosing the right time for surgery. For Median laparotomy revealed a large tumor devel-
this, we must take into account the severity of the oped in the mesentery root; the small intestinal
symptoms, the risk for complications, but also the mass was pushed towards anteriorly. The superior
possible negative outcomes of surgery. pole of the tumor was situated near the eso-gas-
Results and conclusions: For patients with a tric junction and the inferior pole was in the pel-
low growth rate of the abnormal bone and no vis. The tumor developed entirely in the retro-
complications the watch and wait approach peritoneal space, invading the large vessels, the
with periodic imagistic investigations and reas- kidneys and the ureters. The previous mentioned
sessments may be the best therapeutic option, structures were dissected with difficulty. Dissec-
especially in cases where the growth period is not tion led to diffuse bleeding that required hemo-
completed. However, in situations where an in- static wrapping which was removed after 48
tervention is necessary, we must choose between hours. Histopathological exam revealed retroper-
the minimally invasive endoscopic approaches itoneal liposarcoma. Patient had a favorable post-
and the more radical classical open approaches, operative outcome.
trying to reach a balance between the desired sta- Conclusions: Case particularity consisted in
tus of disease free and the approach that guar- the lack of symptoms specific for a retroperito-
antees the best quality of life for the patient. neal tumor, despite the large dimensions reached
by this particular giant tumor and its invasiveness.

ABSTRACTS
(337) Decreasing donor site (338) Chondrosarcoma

morbidity in arthroscopic case report
ACL reconstruction using Marian Pleniceanu
hamstring tendon autograft Emergency University Hospital, Bucharest,
early results Romania
Bogdan Sendrea, Stefan Mogos, Chondrosarcoma is a musculoskeletal tumor

George Viscopoleanu, Radu Orfanu, which, unlike other primary bone tumors that ap-
Ioan Cristian Stoica pear in children and adolescents, can affect pa-
tients of any age. Its aggressiveness is determined
Foisor Clinical Hospital of Orthopedics, by its grading, with low grade chondrosarcomas
Traumatology and Osteo-Articular Tuberculosis, having a good survival rate, and high grade ones
Bucharest, Romania having an increased chance of metastases and a
grim prognosis. The treatment for these tumors is
Objective: The aim of this paper is to discern mainly surgical, because chemotherapy and ra-
arising complications in using only one hamstring diotherapy are not very effective against them.
tendon triple bundled in the anterior cruciate This further underlines the importance of early
ligament reconstruction in comparison with the detection of the tumor which, if detected at an
classic two hamstring tendons quadruple bun- early stage, can save a patient from amputation. A
dled through analysis of clinical parameters re- 22 year old male patient presented in our depart-
corded pre-operatively and at 12 month follow- ment with pain in the left hip, without any injury.
up. A set of investigations were performed, including
Method: Out of the 40 patients enrolled, 6 X-rays, CT, MRI, scintigraphy. The tumor was then
were lost to follow-up, and the remaining 34(18 biopsied and confirmed to be a chondrosarcoma.
females and 16 males) were examined before The patient underwent a wide resection of the
surgery, and 12 months follow-up.17 patients proximal left femur and reconstruction with mod-
benefited from the classic quadruple bundle ular hip and proximal femur prosthesis. Subse-
technique and the remaining 17 from the triple quent check-ups found no metastases and an
bundle technique for arthroscopic ACL recon- overall good evolution. The surgical treatment is
struction. Clinical parameters (Lachman and pivot essential in the evolution and prognosis of this af-
shift test) and differential laxity measurement us- fection and it depends on the grade of the tumor
ing the Rolimeter arthrometer were recorded and and its location. Sometimes amputations are un-
analysed. avoidable, but when found early on, limbs can be
Results: The postoperative data proved con- preserved and with the help of reconstruction
sistent with a favourable and simetric evolution prostheses patients can experience a good quality
between the two groups, in comparison with pre- of life and an early rehabilitation.
operative score values. All patients had positive
preoperative Lachman. Postoperatively, 3 pa-
tients had positive grade I Lachman test (2 in the (339) Narrow band imaging-
triple bundle group). Pivot shift was grade I posi- early detection method for
tive in 6(3 in each group) patients at follow-up
compared to 32 patients pre-operatively. The av- ENT malignancies
erage Rolimeter differential laxity improved from Irina Gabriela Ionita1, Mura Hainarosie1,
from 6.63 mm (6.41 mm for the triple bundle
Octavian Ceachir2, Catalina Pietrosanu1,
group and 7.11 mm for the quadruple bundle
group) pre-operatively to 1.70 mm post-opera- Cristina Zamfir1, Viorel Zainea2, Razvan
tively. None of the patients suffered graft failure, Hainarosie2
infection or donor site complications. 1
Conclusion: For arthroscopic ACL reconstruc- Davila, Bucharest, Romania
tion, the triple bundle technique is comparable 2
Institute of Audiology and Functional ENT
with the classic quadruple bundle technique, re- Surgery Prof. Dr. D. Hociota, Bucharest, Romania
garding clinical parameters, with the advantage of
decreased donor site morbidity. Objective: Early detection of malignancies is
the key for successful management in this type of
pathology. The outcome of the surgical and onco-

ABSTRACTS
logical treatment depends on the stage and the considered in the selection of operable patients.
grading of the neoplasm. Early diagnosis of malig- The aim of the current study was to investigate
nant tumors offers a greater possibility of cure, the relevance of some patient biological parame-
with a good 5 year survival rate. The endoscopic ters for their ability to select candidates for radical
examination of the nose, larynx and pharynx is an surgery that would not develop unwanted post-
important part of the modern methods of ENT operative complications.
examination. Narrow band imaging improves Methods: The current study was conducted
early detection for small tumors in ENT malignan- on a group of 160 patients operated on in the
cies. First Surgical Clinic, Bucharest Institute of Oncol-
Method: Narrow band imaging is a modern ogy Prof. Dr. Al. Trestioreanu, over a period of 16
endoscopic examination technique that uses fil- years. We aimed the acquisition of data referring
ters with specific wavelength for white light that to patient preoperative biological status, associ-
are absorbed differently by haemoglobin, allow- ated diseases, and markers of organ dysfunctions,
ing a better evaluation of the superficial epitheli- such as liver diseases, that were preexistent or ap-
um. Assessment of the vascular pattern of a small peared as a consequence of visceral tumoral
tumor can indicate the benign or malignant char- compression/invasion. In this regard, we evaluat-
acter of that tumor. ed the usefulness of these parameters in selecting
Results: The use of narrow band imaging is an radically operable patients and predicting some
important gain for early detection methods of unwanted intra- and postoperative events, influ-
ENT malignancies. By using this technique we encing patient prognosis.
can diagnose superficial mucosal lesions that Results: An important percent of patients pre-
would be missed by regular white light endosco- sented at their admission either preexistent vis-
py. However, narrow band imaging does not re- ceral dysfunctions (e.g. liver disease as for viral
place the pathological examination of the tissue hepatitis; kidney failure) or secondary to the ex-
fragments taken from the tumor. panding tumoral process. We could remark that
Conclusions: Efforts to achieve the earliest especially the patients presenting preoperative
detection of malignant disease have led to the de- signs of liver dysfunction associated more fre-
velopment of new endoscopic examination quently intraoperative complications, of hemor-
methods that make possible the detection of very rhagic type or anastomotic dehiscences, with im-
small (up to a few millimeters) tumors. Better long portant impact on surgical results, with a decrease
term outcomes in the management of ENT malig- in patient survival.
nancies are expected after introducing these di- Conclusions: Retroperitoneal tumor surgery
agnostic methods in every day medical practice. associates a particular complexity due to patient
advanced tumor stages at the initial diagnosis and
(345) Organ dysfunctions difficulty of access in retroperitoneal space. Pa-
tient precarious biological status either due to tu-
importance for the surgery mor progression or preexisting, adds an addition-
of retroperitoneal tumors al dimension of difficulty in patient surgical
approach. The description of certain limits in the
Angela Madalina Lazar, Dan Nicolae selection process of operable patients for which
Straja, Eugen Bratucu biological status allows an extended surgical in-
tervention compatible with a postoperative re-
First Surgical Clinic, Bucharest Institute of
covery void of significant complications is of ut-
Oncology Prof. Dr. Al. Trestiorean, University of
most importance for patient survival.
Romania, Bucharest, Romania
Objective: Retroperitoneal space is charac-

terized by the development of some of the most
aggressive tumor forms that can reach monstrous
dimensions and respond inconstantly to thera-
pies. During their growth, they often determine
visceral afflictions that supplementary contribute
to patient precarious biological status that comes
in contradiction with extended radical surgery. In
retroperitoneal tumor surgery there is still lack of
clarifications regarding the essential factors to be

ABSTRACTS
(347) Intra- and Conclusions: The acknowledgement of the

fundamental intra- and postoperative factors de-
postoperative predictive termining therapeutic success in retroperitoneal
parameters for the tumor surgery is of utmost importance. As the
radicality of the surgical interventions represents
evolution of the patients the major positive prognostic factor, an approach
with retroperitoneal of these tumors in multidisciplinary surgical teams
neoplasias after a rigorous preoperative patient selection be-
comes necessary. The knowledge of other opera-
Angela Madalina Lazar, Eugen Bratucu, tive factors on which the surgical result and the
Dan Nicolae Straja avoidance of complications depends should lead
to improved therapeutic tactics of special impact
First Surgical Clinic, Bucharest Institute of on patient long-term survival.
Oncology Prof. Dr. Al. Trestiorean, University of
Romania, Bucharest, Romania (352) Short-term results
concerning combined
Objective: Retroperitoneal neoplasias, de-
spite their rarity, are distinguishable by their as- reconstruction for anterior
sociated low 5-year survival rates even after com- cruciate and anterolateral
plex radical surgical interventions. The frequent ligaments
involvement of several visceral or important vas-
cular structures by these voluminous tumors de- George Viscopoleanu, Stefan Mogos,
termines however a significant level of complexity Radu Orfanu, Bogdan Sendrea, Ioan
for the surgical interventions, characterized by
Cristian Stoica
important risks and complications. Even after rad-
ical surgery, often achieved with the cost of tissue Foisor Clinical Hospital of Orthopedics,
sacrifices, 5-year survival rates remain low, of ap- Traumatology and Osteo-Articular Tuberculosis,
proximately 40-50%. The heterogeneous charac- Bucharest, Romania
teristics of this group of tumor impeded until now
a detailed characterization of the factors that Objectives: To present our surgical technique
could improve the postoperative prognostic of and short-term results for combined minimal in-
the patients. The aim of the current study was vasive reconstruction of ALL and ACL.
represented by the evaluation of the significance Methods: 12 patients underwent combined
of intraoperative parameters for the immediate ACL and ALL reconstruction in Foisor Orthopae-
and long-term evolution of operated on patients. dic Hospital between 15.08.2015 15.02.2016.
Methods: We conducted an extensive retro- Selection criteria for combined reconstruction
spective and prospective study on a group of 160 were chronic ACL injury, grade 2-3 pivot shift
patients with different types of retroperitoneal test, high level of sporting activity and involve-
neoplasias, over a period of 16 years. We evalu- ment in pivoting sports. We used an outside-in
ated the importance of several intra- and postop- drilling and fixation technique for the ACL graft,
erative factors on patient overall survival, recur- using a triple beam graft (2X Semitendinosus,
rence and metastatic rates. 1XGracilis) and a V shaped double tunnel tibial
Results: The radicality of the surgical inter- fixation using 2XGracilis graft. Clinical testing in-
ventions represented the main positive prognos- cluded Lachmann and Pivot shift tests. Knee
tic factor. The occurrence of intraoperative and range of motion was measured using a goniome-
immediate postoperative complications, even if ter. A Rolimeter arthrometer was used to measure
diagnosed precociously and treated intensively, knee laxity pre-operatively and post-operatively.
determined a decrease in patient survival and a There were no short term complications recorded
more frequent development of postoperative lo- in the patient group.
coregional recurrences. Along with the achieved Results: We analysed the progress made by
type of surgery, the duration of the operation, inpatients at 6 weeks. There were no short term
traoperative blood loss, requirement of digestive complications. All patients achieved full exten-
anastomoses, had a special significance for the sion and mean flexion value was 124 (110-130).
therapeutic results. Precocious preoperative com- Pre-operative mean Lysholm score was 73.83
plications, although rare, associated lower patient (62-82). The mean pre-operative subjective IKDC
overall survival rates. score was 76.46 (72-81). Regarding the objective

ABSTRACTS
IKDC score, preoperatively 9 patients scored C used for two weeks, then the suture material was
values, 1 patient scored D and two B. The mean removed and motion recovery was allowed. The
differential anterior laxity measured with the Ro- tumor was sent for Pathology exam and for open-
limeter pre-operatively was 81.1mm and this architecture xMAP technology assay.
was significantly reduced to 0.80.5mm. Postop- Result: There were no postoperative compli-
eratively the objective IKDC score was improved cations. Motion was recovered completely. The
for all patients, 8 scoring A and 4 scoring B. Lach- flap integrated very well even if the pedicle was
man and pivot shift signs were negative for the passing through a narrow space between the two
entire group. All patients followed the same re- fingers. There were no turns in skin color during
covery protocol as for ACL reconstruction. motion. There were no recurrence of the tumor
Conclusion: The combined reconstruction of during follow-up (6 months). The Pathological
the ACL and ALL is an effective and safe proce- exam showed no residual tumor and multiplex
dure without significant complications on short- assay revealed HPV 16+.
term and with good results at initial stages of fol- Conclusion: Bowens Disease are extensive
low-up. lesions which can be associated with HPV and
usually need surgical removal, therefore local or
(356) Reconstruction after free flaps must be designed in order to cover large
skin defects, making the plastic surgeon the most
surgical treatment of a rare suited to treat BD.
case of Bowens disease
Tiberiu Paul Neagu1, Khalid Al-Falah1, (360) The multidisciplinary
Serban Arghir Popescu1, Delia Botezatu2, management of the
Mihaela Tovaru2, Ioan Lascar1 sinonasal melanoma
1
Emergency Clinical Hospital, Bucharest, Octavian Ceachir1, Viorel Zainea1, Irina
Romania Gabriela Ionita2, Catalina Pietrosanu2,
2
Clinical Hospital of Infectious and Tropical
Diseases Victor Babes, Bucharest, Romania
Razvan Hainarosie1
1
Institute of Phonoaudiology and Functional ENT
Objective: Bowens disease (BD) or squa- Surgery Prof. Dr. Dorin Hociota, Bucharest,
mous cell carcinoma in situ of the skin is a malig- Romania
2
nant neoplasm restricted to the epidermis with- University of Medicine and Pharmacy Carol
out evidence of dermal invasion. Etiology of BD is Davila, Bucharest, Bucharest, Romania
not clearly understood but various strains of hu-
man papilloma viruses, arsenic exposure and im- Objective: The purpose of this paper is to
mune suppression have been considered as risk present the multidisciplinary management of the
factors. This case is about an atypical site for de- sinonasal malignant melanoma.
veloping this disease associated with human pap- Method: Melanomas are tumors arising from
illoma virus(HPV) 16 as a risk factor for which we melanocytes, which can be found in the basal
designed a particular local flap for reconstruction layers of the epidermis, in the respiratory ephi-
after the surgical ablation of the tumor. thelium of the nasal cavity, in the nasal glands, in
Methods: A 67-year-old male was referred for the stroma of the nasal septum and in the middle
pain and itching on the volar aspect of the hand and inferior turbinates. Melanomas located at the
near the base of the index and middle finger. In level of the nasal and sinusal mucosa are rare and
his past medical history, a biopsy was made after their incidence varies between 0.3-2% of all ma-
a dermatoscopy was performed which revealed lignant melanomas. Their evolution is character-
BD. The patient was guided to a plastic surgery ized by the early local recurrence, extension and
clinic where, under local anesthesia, the tumor frequent metastasis to lymph nodes and viscera,
was removed with safety edges. Direct skin clo- making it one of the most dangerous forms of na-
sure was not possible, so in order to cover the sal and paranasal sinus tumors. The most com-
defect (2.3 cm/2.4 cm) on a functional area, a mon symptoms on presentation are nasal ob-
local flap was designed. The flap was harvested struction, epistaxis, swelling of the nose or visible
from the dorsal aspect of the proximal phalanx mass in the vestibule, pain and nasal discharge.
down to the epitenon and rotated on the volar The macroscopic aspect of the tumor may vary
aspect of the hand between the index and the from macular to nodular or ulcerated. The imag-
middle finger. A thick dressing and a splint was istic exams reveals an uniform soft tissue mass,

ABSTRACTS
while the histopathological report shows epithe- sonography revealed a large amount of fluid in
lial cells with abundant eosinophilic cytoplasm, the abdomen.
round nuclei or spindle cells. The surgical ap- Results: Emergency surgery was performed
proach consists of total resection of the tumor which revealed neglected stercoral peritonitis
with local safety margins and neck nodes control. caused by a cecum diastatic perforation and a 4/5
Medical management, prescribed and supervised cm obstructing tumor, localised at the hepatic co-
by the oncologist, is reserved for adjuvant therapy lonic flexure. Right hemicolectomy with terminal
of patients with advanced melanomas; agents ileostomy was performed. Histopathological
used in this kind of treatment are: interferon alfa, exam tubulo-papilar partial mucosecretory ad-
pegylated interferon and granulocyte-macro- enocarcinoma, stage IIIB. After surgery patient
phage colony-stimulating factor (GM-CSF). Two was transferred to the Intensive Care Unit requir-
relevant cases for this pathology will be presenting vasopressor support and mechanical ventila-
ed. tion. Initial surgical evolution was favourable, un-
Results: The follow-up at 3 and six months til the 11th postoperative day, when peritoneal
after surgery and adjuvant therapy showed no drainage aspect turned from serous to bilious.
signs of recurrence. Surgical intervention was decided. Enteral fistula
Conclusions: Surgery is the treatment of produced by drainage tube lesion was revealed at
choice for early stage melanomas but it can also 150 cm distal from the Treitz angle. Intestinal le-
be used in well selected cases of advanced stage sion was sutured. 72 hours after surgery, the as-
melanomas along with adjuvant medical treat- pect of the abdominal drainage became bilious.
ment. Surgical exploration of the abdominal cavity
showed a suture dehiscence. Segmental enterec-
(365) Rare digestive fistula tomy with excision of the lesion and terminal je-
junostomy was performed. Postoperative evolu-
intraperitoneal drainage tion was unfavourable. The patient died 24 hours
tube lesion case later.
Conclusions: Digestive fistulas by intraperito-
presentation neal drainage tube lesions are extremely rare
Vlad Andrei Porojan, Oana Ilona David, complications encountered in abdominal surgery.
The occurrence of a fistula in this particular type
Ionut Simion Coman, Violeta Elena
of cases (patients with severe comorbidities) may
Radu, Marius Paraschiv, Alexandru Rares dramatically change the postoperative result.
Stoian, Valentin Titus Grigorean
Department of General Surgery, Emergency (371) Mixed osteosynthesis
Hospital Bagdasar-Arseni, Bucharest, Romania
in fractures of distal radial
Objectives: Digestive fistulas by intraperito- epiphysis
neal drainage tube lesions are extremely rare
complications in abdominal surgery, sometimes
Alin Nasser1, Alexandru Lupu1,2, Adrian
secondary to poor quality of the alloplastic mate- Cursaru1,2, Razvan Ene1,2, Georgian
rial. Tissular modifications at the location site may Iacobescu1, Catalin Cirstoiu1,2
be a contributing factor for the appearance of a 1
digestive fistula. Furthermore, an important role is Davila, Bucharest, Romania
held by the patients biological and functional sta- 2
Department of Orthopaedics-Traumatology,
tus. Emergency University Hospital, Bucharest,
Methods: We present the case of a 81 years Romania
old patient, with severe neglected cardiovascular
pathology, presented with severe abdominal Objectives: Mixed osteosynthesis, although
pain. The patient affirmed the lack of bowel less practiced in multitude of cases of tibial pillar
movement and the inability to pass gas for 10 fractures plays an important role in their postop-
days. At admission the patient was with an ex- erative evolution, representing a required surgical
tremely poor clinical condition, hypotensive, solution.
tachycardic. The abdomen was distended and Method: The retrospective study conducted
diffusely tender, showing signs of peritoneal irrita- over a period of five years (01.2011-01.2016),
tion. Abdominal X-ray in a standing position were enrolled 21 patients. The included patients
showed hydroaeric levels while abdominal ultra- in the study were patients with high energy trau-

ABSTRACTS
ma, fractures with a high degree of comminution. erative evolution, representing a required surgical
There were created two groups of patient: (GI) solution.
-12 patients who were practiced closed osteosyn- Method: The retrospective study conducted
thesis percutaneous with screws and external fix- over a period of five years (01.2011-01.2016),
ation and (GII) -9 patients who were opted for were enrolled 21 patients. The included patients
open osteosynthesis with plate and screws under in the study were patients with high energy trau-
the protection of an external retainer. Patients ma, fractures with a high degree of comminution.
were evaluated at 6 months postoperative using There were created two groups of patients: (GI)
the score of Foot & Ankle Disability Index (FADI). -12 patients who were practiced closed osteosyn-
Results: From the total of 21 patients, includ- thesis percutaneous with screws and external fix-
ing 16 men and 5 women, with the age between ation and (GII) -9 patients who were opted for
21 and 54 years, the average age being 37.5 open osteosynthesis with plate and screws under
years. the protection of an external retainer. Patients
In group GI were used on average 4 screws (of were evaluated at 6 months postoperative using
between 3 to 6) under the protection of the ex- the score of Foot & Ankle Disability Index (FADI).
ternal retainer and for GII were used nine AO Results: From the total of 21 patients, there
boards under the protection of the external re- were 16 men and 5 women, with the age be-
tainer. tween 21 and 54 years and the average age being
No significant differences were recorded of 37.5 years.
the results of The Foot & Ankle Disability Index In group GI were used on average 4 screws (of
(FADI) Score between the two groups at 6 months. between 3 to 6) under the protection of the ex-
The scores were the following: an average of 84.6 ternal retainer and for GII were used nine AO
in GI group (of between 68.3 and 90.4) -and in boards under the protection of the external re-
group GII - an average of 86.8 (range between tainer. No significant differences were recorded
66.9 and 92.1). In GI group was one case of de- of the results of The Foot & Ankle Disability Index
(FADI) Score between the two groups at 6 months.
layed of consolidation, while GII group was one
The scores were the following: an average of 84.6
case of infection which/ that necessitate the re-
in GI group (of between 68.3 and 90.4) -and in
moval of the osteosynthesis material.
group GII - an average of 86.8 (range between
Conclusion: Mixed Osteosynthesis with plate
66.9 and 92.1). In GI group was one case of de-
and screws or just screws under the protection of
layed of consolidation, while GII group was one
the external retainer, represents a necessity solu-
case of infection which/ that necessitate the re-
tion in the cases of fractures with a high degree of
moval of the osteosynthesis material.
comminution and the functional differences at 6
Conclusion: Mixed Osteosynthesis with plate
months between the two types of osteosynthesis
and screws or just screws under the protection of
are not significant statistically, but in the case of the external retainer, represents a necessity solu-
group GII the rate of local complication was high- tion in the cases of fractures with a high degree of
er. comminution and the functional differences at 6
months between the two types of osteosynthesis
(373) Mixed osteosynthesis are not significant statistically, but in the case of
group GII the rate of local complication was high-
in complex comminutive er.
fractures of tibial pillar
Alexandru George Lupu1,2, Adrian (375) Reconstruction of the
Cursaru1,2, Marinela Hostiuc2, Georgian tip of the nose using a long
Iacobescu2, Tudor George2, Alin-Kayed and narrow single lobe
Nasser1, Catalin Cirstoiu1,2, Razvan Ene1,2 transposition flap case
1
University of Medicine and Pharmacy Carol report
2
Department of Orthopaedics-Traumatology, Tiberiu Paul Neagu, Serban Arghir
Emergency University Hospital, Bucharest, Popescu, Ioan Lascar
Romania
Emergency Clinical Hospital, Bucharest, Romania
Objectives: Mixed Osteosynthesis, although
less practiced in multitude of cases of tibial pillar Objective: A common site for basal cell carci-
fractures plays an important role in their postop- noma (BCC) is usually the nose. In most cases,

ABSTRACTS
after removal of the tumor with safety edges, local following parameters were evaluated: occurrence
flaps must be designed in order to cover the skin of complications (infection, necrosis of the flap,
defect when the skin graft is not an option. In this wound dehiscence or donor site morbidity, recur-
case report, a large defect was covered using a rence) and patient satisfaction using Visual Ana-
long and narrow single lobe transposition flap af- logue Scale (VAS).
ter removal of a BCC. Results: Minor complications were noted.
Method: A 73-year-woman was admitted in The patient presented lower eyelid edema and
our plastic surgery clinic after being diagnosed ecchymosis, venous insufficiency at the tip of the
with BCC using dermatoscopy. Under general an- flap and small blisters after surgery. After a few
esthesia, the tumor of the tip of the nose was re- days the flap gained a normal aspect, also the
moved with safety edges, down to the muscles edema and ecchymosis were in remission. The
and cartilage plan. The defect resulted (1,5 local management involved ointment applica-
cm/1,6 cm) was covered using a single lobe trans- tion. The pathological exam showed no residual
position flap which measured 4 cm length, 1,2 tumor. The visual aspect of the flap was well ap-
cm at the base of the flap and 1,3 cm at the tip of preciated by the patient (9 on VAS).
the flap. In order to avoid tension and lift of the Conclusion: In this case, a long and narrow
right nostril the incision was prolonged inferior to flap was designed in order to achieve a good aes-
the right base of the alar where small dissection thetic result, pushing a little bit the limits of a nor-
was performed. The dissection was prolonged mal flap measurements. Even if minor complica-
also in the internal cantus in order to be able to tions can occur experience is the key to success in
close de secondary defect without tension. The such cases.
tumor was sent for pathological examination. The

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Volume 11 Supplement 2016

Editor-in-chief Deputy Editors

International Editorial Board Scientific Publishing Committee

PUBLISHER: MEDIA MED PUBLICIS

Address of editorial staff:

Mdica J Clin Med.

Acad. Ioanel SINESCU Congress Chairman, Rector

Abstracts of posters exposed

Young Investigator Award 3

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 1

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 3

4 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

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6 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

The purpose of this study was to investigate (238) Gingival involvement

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 7

8 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 9

10 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

GHAN CD diagnosis guidelines. Data regarding (205) Protective effects of in

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 11

12 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

(280) Antiproliferative (307) New Al(III), Ga(III)

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 13

14 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

fatty liver, Alzheimer, Parkinson) has become an (386) Study of Clopidogrel

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 15

Thiocarbohydrazones (R1R2C=NN(H)C(= SURGICAL SPECIALITIES

16 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

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18 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

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Results: Between 01.01.2014 and

20 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

(9) H-type rectovestibular (40) A cross-sectional survey

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 21

protection methods against airborne diseases (59) Abrikossoff tumor

22 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 23

Objective: Leiomyosarcoma is the most com- (78) Immunohistopathologi-

24 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

January 2016), we reviewed 5 cases of endome- (94) How to use animal

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 25

(97) GLA nonsense mutation (100) Positive and

26 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

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28 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

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30 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

(214) Burnout levels of (216) Functional inter-

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 31

(218) Cerebrovascular (219) The effect of curcumin

32 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

(220) EGCG reduces tions. Since the mitochondrial depolarization can

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 33

Objective: Verocytotoxin-producing Esche-

34 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

(246) Oxidative stress 0.01 in PLGA group vs control group AOPR

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 35

Conclusions: Nomophobia affects a great er stroma. On high-power examination, the en-

Objective: Endometriosis is a common com-

36 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016

Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016 37

38 Maedica A Journal of Clinical Medicine, Volume 11, Supplement, 2016